Spondylolisthesis is an anterior displacement of a (usually lumbar) vertebra in relation to the vertebrae below, due to congenital anomaly, degenerative change or trauma.
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:
Diagnosis is made on the basis of the following.
Conservative treatment is done with the following agents  :
Surgical treatment includes:
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  . Degenerative spondylolisthesis is associated with worsening of symptoms with time and poor prognosis.
Based on etiology, spondylolisthesis is divided into five major categories:
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:
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.