Spondylolisthesis is a condition of either a forward slippage (anteriolisthesis) or a posterior slippage (retrolisthesis) of one vertebrae on another.
There are 5 major variations that occur within the lumbar spine.
- Congenital defect
- Isthmic where there is a defect in the pars interarticularis often caused by repeated traumas
- Degenerative more common in older patients
- Traumatic due to a direct injury
- Pathologic due to a space occupying lesion
Any form of Spondylolisthesis can have neural complications in the form of central canal stenosis or foramina stenosis.
They are described as being either a Low grade <50% slippage or High grade >50% slippage.(1, 2).
Our osteopaths at Coolangatta Tweed Osteopathy can ascertain as to whether this is in fact the cause of your lower back pain.
In children under the age of 6, incidence has been shown to be 2.6% of the population. In adults that number rises to 5.4%.
It is more common in caucasian people, there also seems to be a familial association with the congenital type of spondylolisthesis due to the fact that 26% of the people with this type have another family member with the condition.
Male to female ratio is 2:1 for the isthmic variety.(3, 4)
Signs & Symptoms
- A palpable slippage over the Spinous processes
- Tenderness upon palpation of lesion often causing familiar pain
- Hamstring hypertonicity
- Muscular spasms in associated area
- Limited flexion
- Neurological weakness in lower limb
Lab Tests
No Specific Lab tests to diagnose Spondylothesis
Imaging
Radiographs of the lumbar spine are the gold standard for diagnosis and typically include anteroposterior, lateral, lateral flexion and extension, and oblique views.
These are usually sufficient to diagnose spondylothesis and grade it based on the displacement seen. If neurological signs are present due to the possibility of central canal stenosis, an MRI of lumbar spine or CT myelogram should also be performed.
Review of Evidence for Management
Depending on the severity of slippage, my first line management will usually exhaust conservative measures before surgical intervention is considered.
Osteopathic conservative measures will include the modification of activities to reduce the aggravating factors, NSAID medication, bracing and specific strengthening and stretching exercises.(4)
A recent systematic review determining the efficacy of manual therapy interventions have shown that trunk stabilising exercises as well as combined extension exercises, extension bracing, and patient education are beneficial in the conservative treatment of spondylothesis.(5)
If after a 3 to 6-month period conservative treatment is showing no results in patient symptoms and pain disability measures, surgery is the next path to consider.
The main aim of surgery is to decompress neural elements and stabilise hypermobile segments of the spine. This is usually done by stopping motion across the facet joint and intervertabral disc by means of fusion.
This has proven to be more effective than continued conservative treatment in this patient population.(4, 6)
Sources:
- Palmer E. Spondylolisthesis. In: Richman S, editor. Ipswich, Massachusetts: EBSCO Publishing; 2013.
- Mac-Thiong J-M, Labelle H. Classification of pediatric lumbosacral spondylolisthesis. Studies In Health Technology And Informatics. 2006;123:141-5.
- Tebet MA. Current concepts on the sagittal balance and classification of spondylolysis and spondylolisthesis. Revista Brasileira de Ortopedia (English Edition). 2014;49(1):3-12.
- Vokshoor A. Spondylolisthesis, Spondylolysis, and Spondylosis 2012 [cited 2014 7th September]. Available from: https://emedicine.medscape.com/article/1266860-overview#a0199.
- McNeely ML, Torrance G, Magee DJ. A systematic review of physiotherapy for spondylolysis and spondylolisthesis. Manual Therapy. 2003;8(2):80-91.
- Kovacs FM, Urrutia G, Alarcon JD. Surgery versus conservative treatment for symptomatic lumbar spinal stenosis: a systematic review of randomized controlled trials. Spine. 2011;36(20):E1335-51.
