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Condition/Disorder Synonyms

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  • Congenital spondylolisthesis

  • Isthmic spondylolisthesis

  • Degenerative spondylolisthesis

  • Traumatic spondylolisthesis

  • Pathologic spondylolisthesis

  • Spondylolisthesis aquista

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ICD-9-CM Codes

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  • 738.4 Acquired spondylolisthesis

  • 756.12 Spondylolisthesis congenital

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ICD-10-CM Codes

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  • M43.10 Spondylolisthesis, site unspecified

  • Q76.2 Congenital spondylolisthesis

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Preferred Practice Pattern

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Key Features

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Description

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  • Anterior (forward) translation of a vertebra

  • Fracture of the pedicles on vertebra below

  • Slipping of the vertebra in relationship to vertebra below

  • Neurogenic claudication

  • Fracture widens at the pars

  • Congenital spondylolisthesis

    • Dysplasia of the L5 vertebra and sacral arches

  • Isthmic spondylolisthesis

    • Acute fracture, stress fracture, elongation of the pars

  • Degenerative spondylolisthesis

    • Wear and tear to L4-L5 vertebrae

  • Traumatic spondylolisthesis

    • Fracture or acute dislocation of the zygapophysial joint

  • Pathologic spondylolisthesis

    • Systemic disease causing weakness

  • Spondylolisthesis aquista

    • Surgical disruption of the ligament or bone

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Essentials of Diagnosis

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  • Diagnosis made by x-ray

  • Can be acquired or congenital

  • Clinical examination may find step deformity

  • Dermatome/myotome pattern

  • Four grades2

    • Grade 1: 0 to 25% slippage

    • Grade 2: 25 to 50% slippage

    • Grade 3: 50 to 75% slippage

    • Grade 4: 75 to 100% slippage

  • Low-grade isthmic spondylolisthesis: less than 50% displacement

  • High-grade isthmic spondylolisthesis: greater than 50% displacement

  • Spondylolysis: fracture without displacement

  • Hangman's fracture

    • C2 vertebra anteriorly translated on C3 with fracture of C2 pedicles

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General Considerations

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  • Instability

  • Herniated disk is one cause of radiculopathy

  • Avoid extension positions that increase symptoms

  • Refer to Wiltse-Newman classification of spondylolisthesis

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Demographics

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  • Can be congenital or acquired

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Clinical Findings

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Signs and Symptoms

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  • Pain in lumbar, hip, buttock, leg, lower extremity; parasthesia often radiating into the foot

  • Stiffness along spine

  • Pain in lumbar spine worsens with extension

  • Diminished sensation, motor control, reflexes in the distribution of involved nerve

  • Neurogenic claudication

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Functional Implications

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  • Difficulty maintaining standing postures secondary to back and leg pain

  • Inability to sleep on back

  • Weakness with lifting, prolonged standing

  • Loss of movement or feeling in lower extremity

  • Loss of bowel and bladder control if severe

  • Difficulty with movements (as with driving, twisting) secondary to pain

  • Limit sports participation

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Possible Contributing Causes

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  • Increased lumbar lordosis posture due to tight hip flexors, weak abdominal muscles

  • Congenital

  • Car accident, hit from rear

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Differential Diagnosis

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  • Peripheral nerve impairment

  • Piriformis syndrome

  • Hip pathology with radiating pain pattern

  • Spinal tumor

  • Infection

  • Peripheral neuropathy

  • Sciatica

  • Paraspinal spasms

  • Degenerative disk disease

  • Sacral or pelvic dysfunction

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Means of Confirmation or Diagnosis

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Imaging

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  • MRI helps to visualize compressed or inflamed nerve root ...

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