Spondylolisthesis most commonly involves lumbar vertebrae at the level of L4-5 and less commonly, at L3-4. Unilateral or bilateral stress fracture of the pars interarticularis is common. Clinical features include:

• Lower back pain, that worsens after exercise and on coughing and sneezing
• Radiation of pain to the legs along the course of sciatic nerve
• Tingling sensation or numbness in the legs
• Tightness of the hamstring muscles
• Slipping sensation while moving upright
• Muscle spasms
• Reduction in the range of motion of lower back
• Kyphosis
• Abnormal gait (waddling gait)

In severe cases, the patient may develop cauda equina syndrome which is characterized by loss of bladder and bowel tone and their dysfunction.

• Difficulty Walking

  Symptoms Low back and/or buttock pain Radiating leg pain, numbness, weakness Cramping leg pain and numbness Difficulty standing Difficulty walking Heaviness in legs Treatment In adults, lumbar spondylolisthesis is initially treated by medications, physical [uncmedicalcenter.org]

  This can lead to leg pain, difficulty walking, incontinence, insomnia, and inability to function. Spondylolisthesis can lead to spinal stenosis with pain in the extremities with movement. [emedicinehealth.com]

  Some of the most common symptoms include: difficulty walking or running pain in the lower back or buttocks pain that travels from the back down one or both legs weakness in one or both legs pain in lower back and legs that is aggravated by movement or [medicalnewstoday.com]

• Lower Extremity Pain

  New or worsening low back pain and lower extremity pain were reported over an average period of 19.0 ± 17.5 months postoperatively. [ncbi.nlm.nih.gov]

  Backache (lumbar pain) that often extends to the lower extremities. However, many patients with spondylolisthesis report no symptoms, while others report only lower extremity pain. [orthopedia.gr]

  extremity pain are provided. [radsource.us]

  Epidural steroid injections can be used to relieve low back pain, lower extremity pain related to radiculopathy and neurogenic claudication.[20] A brace may be useful to decrease segmental spinal instability and pain. [21] Physiotherapy focuses on relieving [physio-pedia.com]

• Rigor

  Adults with spondylolysis are also often counseled to avoid rigorous exercise and/or physically demanding jobs. [spine-health.com]

  URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. [account.allinahealth.org]

  Maintain the strength in your back and abdominal muscles Maintain a healthy weight Eat a well-balanced diet Protect your back during sports or rigorous activities Correct your posture Stop smoking and avoid excessive consumption of alcohol Learn to lift [bonati.com]

  Unfortunately, rigorous comparative research is lacking on which to base clinical practice guidelines for diagnosis (as well as treatment) of spondylolysis and spondylolisthesis.18 Nevertheless, current standards call for a detailed physical examination [mdedge.com]

• Pathologist

  Rokistanky (1804-1878), an Austrian pathologist, was the first who described spondylolisthesis in 1839 8. Quiz questions References Related articles: Spinal trauma Promoted articles (advertising) [radiopaedia.org]

• Abdominal Pain

  rhizotomy, epidurals, opioid tapering, abdominal pain, pelvic pain, PTSD management via US guided stellate ganglion blocks, refractory VT treatment via US guided stellate ganglion block, refractory chronic plantar fasciitis View Full Profile James Kryzanski [tuftsmedicalcenter.org]

  In some cases, a spondylolysis may be discovered in the spine of some teenagers and children when they undergo a CT scan for unrelated reasons, such as abdominal pain or after an accident. Single Photo Emission Computed Tomography (SPECT) scans. [orthoinfo.aaos.org]

  A CT scan of the abdomen and the pelvis was performed for his abdominal pain. We administered 75 ml of Optiray 350 intravenously, and the imaging demonstrated mild diverticulosis in the sigmoid colon without any evidence of diverticulitis. [ncbi.nlm.nih.gov]

• Back Pain

  Key Spondylolisthesis Symptoms Lower Back Pain The most frequent symptom of lumbar spondylolisthesis is lower back pain. The pain typically worsens after exercise and abates when you sit or bend forward. [premiaspine.com]

  It may put pressure on a nerve, which could cause lower back pain or leg pain. [my.clevelandclinic.org]

• Low Back Pain

  The patients presented with intractable chronic low-back pain. Plain radiographs and 2D CT scanning revealed the presence of the aforementioned anomalies. [ncbi.nlm.nih.gov]

  If you are experiencing symptoms of spondylolisthesis, the most common symptom is low back pain that feels like a muscle strain. [mercy.com]

  If you're experiencing low back pain, don't worry as you're not alone. If you have never experienced low back pain consider yourself lucky! [livestrong.com]

  Isthmic spondylolisthesis is one of the most common causes of low back pain in young adults, adolescents and children. [sciatica.com]

• Lordosis

  After the treatment period, lumbar lordosis, sacral slope and anterior pelvic tilting decreased 17.2°, 16.5° and 15.1° respectively. [ncbi.nlm.nih.gov]

  L4-L5 20° of lordosis (representing 28% of total lumbar lordosis) L5-S1 28° of lordosis (representing 39% of total lumbar lordosis) For a total of 48° representing 67% of the total lumbar lordosis. [www2.aofoundation.org]

• Osteoporosis

  Spondylolisthesis is a condition commonly caused by osteoporosis. It is characterized by a slipping forward of one or more of the vertebrae. This distortion and misalignment of the spinal column causes pressure on the spinal cord and nerve roots. [urmc.rochester.edu]

  Furthermore this patient is regularly seen for benign rheumatoid polyarthritis complicated by steroid-induced osteoporosis. A preventive treatment was implanted with good results on pain improvement and functional capacities. [ncbi.nlm.nih.gov]

  Bone problems, such as osteoporosis or low bone density, also may be contributing factors. Sudden injury or trauma to the spine also can cause spondylolisthesis. More often, however, stress fractures caused by repeated use over time are responsible. [utahorthopediccenters.com]

  This may be related to fractures occurring due to osteoporosis. Similarly, African Americans are more likely to develop lumbar spondylolisthesis. [ntneurosurgery.com]

  Pathological spondylolisthesis can occur if your bones become weakened by an infection or by a disease like osteoporosis. Post-surgical spondylolisthesis can happen after certain surgical procedures. [aurorahealthcare.org]

• Spine Pain

  You may notice: Pain in the spine Pain, pins and needles, numbness or weakness due to pressure on nerve roots (running down the legs or arms) Difficult walking due to pain or a feeling of clumsiness A change in the shape of your back with flattening of [britscoliosissoc.org.uk]

  pain  lumbosacral region discopathy  mild spondylolisthesis  degenerative changes  completing the healing after orthopaedic surgery  spinous and transverse process fractures  post-surgery stabilisation of the lumbosacral region  strengthening [msa.sm.ee]

  Severe trauma to the thoracic spine means a major, high impact, direct injury to the thoracic spine which produces immediate thoracic spine pain and precludes unaided ambulation for a period of at least 2 weeks, and is associated with other fractures [veterans.gc.ca]

• Fear

  Patients with chronic LBP show poor self-efficacy and heightened fear of movement [23, 24] and these issues may be present also in SPL due to an awareness of vertebral slipping and fear of damage [25]. [archivesphysiotherapy.biomedcentral.com]

  Often adolescents are pulled from their sports participation because of fears that their spondylolysis will lead to spondylolisthesis (slippage of the affected vertebra) and that the slippage will become so severe as to cause permanent damage or paralysis [spine-health.com]

  Spondylolisthesis and spondylolysis are terms that strike fear into the hearts of many, even if it’s only how to pronounce the words or to spell them. [bodyorganics.com.au]

  "The influence of pain and pain-related fear and disability beliefs on walking velocity in chronic low back pain". International Journal of Rehabilitation Research. 26 (2): 101–8. doi:10.1097/00004356-200306000-00004. ISSN 0342-5282. PMID 12799603. [en.wikipedia.org]

• Sciatica

  This is painful if you have tight hamstrings or sciatica caused by spondylolisthesis. The GP may arrange an X-ray to see if a bone in your spine has slipped forward. [nhs.uk]

  Patients where slippage (spondylolisthesis) occurs resulting in nerve pain (sciatica), surgery needs to address the sciatica as well as the instability of the spine. [schoen-clinic.co.uk]

  It can cause sciatica, spinal stenosis, damage to the spinal cord, or pinch nerves. [med.virginia.edu]

  RESULTS: At an average follow-up of 2.8 years, the mean score on the VAS of back pain and sciatica decreased from 6.48 and 4.26 points preoperatively to 1.82 and 1.10 points at final follow-up, respectively. [ncbi.nlm.nih.gov]

  It might be better, he said, to focus on patients who don't improve and progress to chronic sciatica. [health24.com]

• Dizziness

  The patient was a 27-year-old male with a 12-month history of vertigo and dizziness in relation to head movements. [ncbi.nlm.nih.gov]

  Side effects include nausea, constipation, dizziness and drowsiness, and use can result in dependency. All medication should be taken only as directed. [knowyourback.org]

  The main problem was dizziness, which affected 40% of people taking the drug. [health24.com]

• Vertigo

  The patient was a 27-year-old male with a 12-month history of vertigo and dizziness in relation to head movements. [ncbi.nlm.nih.gov]

Diagnosis is made on the basis of the following.

• History
• Myelography with injection of radiopaque dye
• X-ray of lumbar spine
• Computerized tomography imaging
• Magnetic resonance imaging

Conservative treatment is done with the following agents [3] [4]:

• Non-steroidal anti inflammatory drugs (NSAIDs) are given to reduce inflammation and alleviate the pain. Other potent analgesics may also be given.
• Oral steroids (such as prednisone or methylprednisolone) can be given in severe cases. Epidural steroid injections may also be given.
• Physiotherapy, lumbar traction, thermal treatment, electrical stimulation and lumbosacral orthoses are other treatment options for the management of spondylolisthesis.
• Braces are recommended for spinal support.
• Chiropractic therapy can also help in reducing the severity of symptoms.

Surgical treatment includes:

• Spinal fusion. The three most common methods are postero-lateral (intertransverse) fusion, lumbar interbody fusion and pars repair [5] [6]. Antiplatelet and anti-inflammatory therapies are the contraindications of fusion.
• In situ anterior fusion (ALIF), for high grade spondylolisthesis [7]
• Fixation
• Decompression [8] [9]
• Reduction [10]

Rehabilitation therapy should also be included in the treatment.

The prognosis of the disease is usually good, with a large majority of patients responding to conservative therapeutic measures. Rarely, involvement of nerve roots can lead to concomitant morbidities like cauda equina syndrome.

Surgical treatment may take up to 3 months to heal but the patients usually recover with excellent prognosis [1] [2]. Degenerative spondylolisthesis is associated with worsening of symptoms with time and poor prognosis.

Based on etiology, spondylolisthesis is divided into five major categories:

• Isthmic spondylolisthesis: This is the most common form of spondylolisthesis. A defect in pars interarticularis leads to this form. Hyperextended posture is the common cause.
• Dysplastic spondylolisthesis: This develops due to defect in the development of vertebral facets. It is a congenital disorder.
• Pathologic spondylolisthesis: This develops as a result of bone disorders. 
• Traumatic spondylolisthesis: This results due to direct trauma to the spine. Fractures of pedicle, lamina or facet joints are commonly associated with this form.
• Degenerative spondylolisthesis: Arthritic changes in the joints contribute to the development of this form of spondylolisthesis. It is the common in old age.

A prevalence rate of 5-7% has been found in the United States population. Spondylolisthesis is common in athletes and gymnasts as a result of hyperextended postures. Patients with family history of bone defects are more prone to develop spondylolisthesis. It is also common in old age.

Pars interarticularis or isthmus is present in the posterior part of the vertebra. It may be congenitally absent (dysplastic), or may sustain damage as a result of repeated strain (isthmic) or direct trauma (traumatic). The posterior support of vertebrae is lost (intersegmental instability) and the vertebra slips on the underlying vertebra. Defective bone mineralization (pathologic) and degenerative changes can also lead to spondylolisthesis. The spinal canal may undergo narrowing and stenosis. Nerve roots may also be crushed leading to pain along the course of the involved nerve.

Meyerding’s classification system divides spondylolisthesis into 4 grades depending upon the degree of slippage of the involved vertebra:

• Grade 1: Less than or equal to 25% anterior displacement as compared to the underlying vertebra.
• Grade 2: 26% to 50% anterior displacement.
• Grade 3: 51% to 75% anterior displacement.
• Grade 4: More than 75% anterior displacement.

• Avoiding undue pressure on the vertebrae while exercising can help prevent spondylolisthesis.
• Mild exercises that strengthen the back muscles should be done according to the advice of physiotherapist.
• Smoking has been found to contribute to failure of fusion procedure so, it should be avoided. Similarly, alcohol should be avoided.
• Complete rest should be observed by such patients.
• Posture should be maintained to avoid stress on the spinal column. Back should be kept straight and the shoulders, square, without hunching over.
• Healthy, low-fat and low-sodium diet should be consumed.
• In obese people, weight loss can help reduce the severity of symptoms by decreasing the strain on the spinal column.
• Lifting heavy weights should be avoided during post-operative period to prevent recurrence.

Spondylolisthesis is the condition in which a vertebra slips forward in position relative to the adjacent vertebra. The forward sipping is also known as anterolisthesis, whereas, the backward displacement of a disc is known as retrolisthesis. A number of causes contribute to the development of this disease.

The patient may remain asymptomatic or have varying degrees of symptoms depending upon the degree of slippage. Spinal deformities and nerve abnormalities constitute the complications of spondylolisthesis.

Spondylolisthesis is the disease in which one of the vertebrae of the spinal column slips forward on the one lying beneath it. The causes of the disease may include trauma, bone erosion or degenerative changes occurring in the bones with age.

The common presentations of this disorder are pain in the lower back region that might spread to the buttocks and the back of legs. Muscle cramps are common. The person may develop abnormal posture and gait due to severity of the symptoms.

The patient is treated with anti-inflammatory drugs. Physiotherapy is the first line of treatment. Complicated cases are surgically treated. The patient usually recovers and the risk of morbidity is low.

1. Luczkiewicz P, Smoczynski A, Smoczynski M, Lorczynski A, Piotrowski M. [The long-term results of decompression and anterior lumbar interbody fusion for the treatment of degenerative lumbar spondylolisthesis].
2. Chirurgia narzadow ruchu i ortopedia polska. 2004;69(3):173-177.
   Levenets VN. [Long-term results of surgical treatment of spondylolisthesis]. Ortopediia travmatologiia i protezirovanie. Oct 1977(10):52-53.
3. Delpierre J. [Conservative treatment of spondylolysis and spondylolisthesis]. Acta orthopaedica Belgica. Jul-Oct 1981;47(4-5):464-467.
4. Magora A. Conservative treatment in spondylolisthesis. Clinical orthopaedics and related research. Jun 1976(117):74-79.
5. Lubbers T, Bentlage C, Sandvoss G. [Anterior lumbar interbody fusion as a treatment for chronic refractory lower back pain in disc degeneration and spondylolisthesis using carbon cages - stand alone]. Zentralblatt fur Neurochirurgie. 2002;63(1):12-17.
6. Yuan JD, Wang J, Zhou HB, Fu Q, Chen ZM, Zhao J. [Analysis of results on minimum 4-year follow-up of modified posterior lumbar interbody fusion for the treatment of isthmic spondylolisthesis]. Zhongguo gu shang = China journal of orthopaedics and traumatology. Jul 2010;23(7):519-522.
7. Pankowski R, Smoczynski A, Roclawski M, et al. Operative treatment of isthmic spondylolisthesis with posterior stabilization and ALIF. Cages versus autogenous bone grafts. Studies in health technology and informatics. 2012;176:311-314.
8. Hrabalek L, Wanek T, Adamus M. [Treatment of degenerative spondylolisthesis of the lumbosacral spine by decompression and dynamic transpedicular stabilisation]. Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca. 2011;78(5):431-436.
9. Luczkiewicz P, Smoczynski A, Smoczynski M, Pankowski R, Piotrowski M. [The results of decompression and anterior lumbar interbody fusion with the use of interbody cages for the treatment of degenerative lumbar spondylolisthesis]. Chirurgia narzadow ruchu i ortopedia polska. 2006;71(3):173-175.
10. Gong K, Wang Z, Luo Z. Reduction and transforaminal lumbar interbody fusion with posterior fixation versus transsacral cage fusion in situ with posterior fixation in the treatment of Grade 2 adult isthmic spondylolisthesis in the lumbosacral spine. Journal of neurosurgery. Spine. Sep 2010;13(3):394-400.