Spondylolisthesis

• Spondylolisthesis:

  • Spontaneous anterior/posterior vertebral body slippage over the bone below it
  • Most commonly affects lumbosacral articulation
• Causes:

  • Any process that weakens support mechanisms keeping vertebral bodies aligned
  • Degeneration (OA)
  • Trauma
  • Pathological - malignancy, infection
  • Congenital causes
• Presentation

  • Intermittent, localized pain exacerbated by flexing and extending affected spinal segment
  • Pain can sometimes improve when lying flat
  • Exacerbated by direct palpation of affected segment
  • Can cause myelopathy if causes spinal stenosis
  • Can compress nerve roots and cause radiculopathy
  • Limited range of movement
  • Change in gait - often waddling
• Imaging:

  • X-ray initially
  • CT - best sensitivity and specificity for diagnosis
  • MRI useful to assess nerves and soft tissues
• Treatment:

  • Conservative (only if mild symptoms with no risk to spinal cord) - NSAIDs, heat, physio, traction, bracing
  • Surgery - decompression and fusion