Spondylolisthesis

  • Spondylolisthesis is the forward translation of a vertebra, most commonly L5’. They can be graded as I to IV depending on severity 
  • Most commonly caused by age related wear and tear or a degenerative disease such as arthritis.
  • Other possible causes include fractures a result of sudden injury or continued pressure on the spine such as in gymnasts and weight lifters. Or can be associated with bilateral pars defect that can develop in early childhood due to family predisposition

 

Spondylolisthesis

Lumbar midline sagittal T2-weighted magnetic resonance images. Grade 2 L5-S1 spondylolisthesis (case 1, left) and combined grade 2 L5-S1 anterolisthesis and grade 1 L4-5 retrolisthesis (case 3, right) are shown.

 

Subjective History:

Symptoms can start gradually and some may not be aware they have spondylolisthesis at all as it can be asymptomatic, especially if its grade I. Grade II and above slips can present as low back pain with or without leg symptoms. The back pain will often be aggravated by  extension activities.

Objective Examination:

  • Symptoms worsened by extension
  • There may be a palpable dip at the level of the slip and associated soft tissue abnormalities
  • Tight hamstrings

Refer to Physiotherapy:

  • With acute symptoms initial management should include rest from aggravating activities
  • NSAID’s can be used to manage pain as well as spinal mobilisation avoiding the level of the slip
  • Spinal stabilising exercises can be started as comfortable 
  • Hamstring stretching if symptomatic
  • Back braces are rarely recommended as they can lead to weakening in the long term

Treatment for athletic patients:

  • Follow the same guidelines as above with return to sport when they are painfree into extension and can demonstrate good spinal stability
  • With grade III and IV spondylolisthesis high speed activities and contact sports should be avoided.
  • If conservative management fails steriod injections or surgical options can be explored if indicated.

 

References

  • Image from OpenI – Licensed by CC
  • Image from OpenI – Licensed by CC
  • Image from OpenI – Licensed by CC

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