Spondylolisthesis, lumbar

• Congenital spondylolisthesis
• Isthmic spondylolisthesis
• Degenerative spondylolisthesis
• Traumatic spondylolisthesis
• Pathologic spondylolisthesis
• Spondylolisthesis aquista

• 738.4 Acquired spondylolisthesis
• 756.12 Spondylolisthesis congenital

• M43.10 Spondylolisthesis, site unspecified
• Q76.2 Congenital spondylolisthesis

• 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and ROM Associated with Localized Inflammation1

Description

• 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

Essentials of Diagnosis

• 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

General Considerations

• Instability
• Herniated disk is one cause of radiculopathy
• Avoid extension positions that increase symptoms
• Refer to Wiltse-Newman classification of spondylolisthesis

Demographics

• Can be congenital or acquired

Signs and Symptoms

• 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

Functional Implications

• 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

Possible Contributing Causes

• Increased lumbar lordosis posture due to tight hip flexors, weak abdominal muscles
• Congenital
• Car accident, hit from rear

Differential Diagnosis

• 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

Imaging

• MRI helps to visualize compressed or inflamed nerve root in diagnosis
• X-ray/plain-film radiograph to see vertebra position, (Scottie dog collar)
• CT to show herniation compressing the spinal canal/nerves
• Electrodiagnostic/nerve conduction testing can help to determine specific impaired nerve function

• Physical examination to ...