Spondylolisthesis

Question 1

Definition/Description:

Answer 1

The term spondylolisthesis is derived from the Greek words spondylo = vertebra, and listhesis = translation.Spondylolisthesis is defined as a translation of one vertebra over the adjacent caudal vertebra. This can be a translation in the anterior (anterolisthesis) or posterior direction (retrolisthesis) or, in more serious cases, anterior-caudal direction.It is classified on the basis of etiology into the following six types by Wiltse: Dysplastic (congenital), isthmic, degenerative, traumatic, pathologic and iatrogenic spondylolisthesis

Question 2

Anatomy

Answer 2

Spondylolysthesis, regardless of the type, is mostly common preceded by spondylolysis. This pathology involves a fractured pars interarticularis of the lumbar vertebrae, also called the isthmus.

This affects the supporting structural integrity of the vertebrae, which could lead to slippage of the corpus of the vertebrae, called spondylolysthesis.

This, in turn, leads to one of the most obvious manifestations of lumbar instability. This slippage can occur in 2 directions: most commonly in anterior translation, called anterolisthesis, or a backward translation, called retrolisthesis.

In addition, ligamentous structures, including the iliolumbar ligament, between L5 and the sacrum, are stronger than those between L4 and L5, by which the vertebral slip commonly develops in L4
A study of Dai L.Y. analysed the correlation between disc degeneration and the age, duration and severity of clinical symptoms and grade of vertebral slip. The disc degeneration on subsegmental level was significantly related to age and duration of clinical symptoms, although it was not related to the severity of clinical symptoms or the grade of vertebral slip

Question 3

Characteristics/Clinical Presentation:

Answer 3

Symptoms and findings in spondylolisthesis are:

Low-back pain
Pain radiating down the leg
Neurological symptoms (possible evolution towards cauda equine syndrome)
Atrophy of the muscles, muscle weakness
Tense hamstrings, hamstrings spasms
Diminished ROM (spine)
Disturbances in coordination and balance

Patients usually report that their symptoms vary as a function of mechanical loads (such as in going from supine to erect position) and pain frequently worsens over the course of the day.

Radiation into the posterolateral thighs is also common and is independent of neurological signs and symptoms.

The pain could be diffuse in the lower extremities, involving the L5 and/or L4 roots unilaterally or bilaterally, but generally bilaterally [

Symptoms decrease with sitting or standing with lumbar flexion and with lying. As symptoms worsen patients are more and more limited in their activities and walking distance. This relationship is known as neurogenic intermittent claudication[

Question 4

Spondylolisthesis can occur with other disorders and seems to have a link with some of them:

Answer 4

Spina Bifida Occulta , Several studies support a positive association between spina bifida occulta and spondylolysthesis
This high association may not be due to mechanical factors but to genetic factors

Cerebral Palsy A number of studies proved the association between cerebral palsy and spondylolysthesis, certainly in athetoid cerebral palsy (60%)

Scheuermanns Disease also known as Schuermann’s Kyphosis; Ogilvie and Sherman reported a 50% incidence of spondylolIsthesis in 18 patients with Scheuermann’s disease Greene et al. found spondylolIsthesis (grade I or II) at L5-S1 in 32% of patients with Scheuermann’s disease

Scoliosis: Fisk et al. reported that the incidence in 539 patients with idiopathic scoliosis was 6.2%, which corresponded to that found in the general population . But the relation between scoliosis and spondylolisthesis has not been clarified

Spinal stenosis