Contents

Search

spondylolisthesis (listhesis, olisthesis)

Subluxation of the body of a vertebra on the vertebra below. (at least 3 mm at the lumbar spine) Etiology: - trauma - motor vehicle accident Epidemiology: - prevalence of lumbar spondylolisthesis 8.7% Pathology: 1) sacrum may become more vertical, impairing hip extension 2) neurologic involvement is uncommon because vertebra slips anteriorly, away from spinal cord & nerve roots Clinical manifestations: 1) prominent spinal process may be palpable 2) impaired gait, flexed knee, flexed hip (Phalen-Dickson sign) 3) leg pain upon prolonged standing or walking [9] 4) exercise in sitting position (cycling) generally tolerated 5) neurologic involvement is uncommon Radiology: - standing flexion-extension radiographs of lumbar spine - subluxation a vertebral body on the vertebra below - images - radiograph of C2 [8] - computed tomography through C2 (image) [8] Complications: - spinal stenosis Differential diagnosis: - sciatica Management: 1) treatment is controversial 2) chiropractic manipulation is considered to be helpful 3) physical therapy 4) lumbar bracing to prevent hyperextension 5) rest 6) non-steroidal anti-inflammatory agents 7) referral to orthopedic surgeon [4] 8) indications for surgical fusion a) intractable pain b) growing child with slippage > 50% 9) addition of fusion to decompression in patients with lumbar spinal stenosis & spondylolisthesis may have small benefit [7] - decompression + fusion no better than decompression alone [11] 10) epidural glucocorticoids dont seem to effect surgical or non-surgical management of degenerative lumbar spondylolisthesis[10]

Related

back pain spondylitis spondyloarthropathy (HLA B27-associated arthritis, seronegative spondyloarthropathy) spondylolysis spondylosis

Specific

anterolisthesis retrolisthesis spondyloptosis

General

sign/symptom

References

  1. Vogt MT, Rubin DA, Palermo L, Christianson L, Kang JD, Nevitt MC, Cauley JA. Lumbar spine listhesis in older African American women. Spine J. 2003 Jul-Aug;3(4):255-61. PMID: 14589183
  2. Iguchi T, Wakami T, Kurihara A, Kasahara K, Yoshiya S, Nishida K. Lumbar multilevel degenerative spondylolisthesis: radiological evaluation and factors related to anterolisthesis and retrolisthesis. J Spinal Disord Tech. 2002 Apr;15(2):93-9. PMID: 11927816
  3. Pellengahr C, Pfahler M, Kuhr M, Hohmann D. Influence of facet joint angles and asymmetric disk collapse on degenerative olisthesis of the cervical spine. Orthopedics. 2000 Jul;23(7):697-701. PMID: 10917245
  4. UpToDate 14.1 http://www.utdol.com
  5. Weinstein JN et al, Surgical versus nonsurgical treatment for lumbar degenerative spondylolisthesis N Engl J Med 2007, 356:2257
  6. Diagnosis and treatment of degenerative lumbar spondylolisthesis. North American Spine Society PMID: 10917245 http://www.spine.org/Documents/Spondylolisthesis_Clinical_Guideline.pdf
  7. Ghogawala Z, Dziura J, Butler WE et al Laminectomy plus Fusion versus Laminectomy Alone for Lumbar Spondylolisthesis. N Engl J Med 2016; 374:1424-1434. April 14, 2016 PMID: 27074067 http://www.nejm.org/doi/full/10.1056/NEJMoa1508788
  8. Khelifi A, Saadaoui F. (case presentation) Traumatic Spondylolisthesis of the Axis. N Engl J Med 2017; 376:1782May 4, 2017 PMID: 28467872 http://www.nejm.org/doi/full/10.1056/NEJMicm1405867
  9. Geriatric Review Syllabus, 10th edition (GRS10) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2019
  10. Gerling MC et al. Epidural steroid injections for management of degenerative spondylolisthesis: Little effect on clinical outcomes in operatively and nonoperatively treated patients. J Bone Joint Surg Am 2020 Aug 5; 102:1297 PMID: 32769595
  11. Austevoll IM et al. Decompression with or without fusion in degenerative lumbar spondylolisthesis. N Engl J Med 2021 Aug 5; 385:526. PMID: 34347953 - Lau KKL et al. Demographic, surgical, and radiographic risk factors for symptomatic adjacent segment disease after lumbar fusion: A systematic review and meta-analysis. J Bone Joint Surg Am 2021 Aug 4; 103:1438. PMID: 34166276

Images

images related to spondylolisthesis