Spondylolisthesis (cont.)
What are the risk factors for spondylolisthesis?
Risk factors for spondylolisthesis include a family history of back problems.
Other risk factors include a history of repetitive trauma or hyperextension of
the lower back or lumbar spine. Athletes such as gymnasts, weight lifters, and
football linemen who have large forces applied to the spine during extension are
at greater risk for developing isthmic spondylolisthesis.
What are the symptoms of spondylolisthesis?
The most common symptom of spondylolisthesis is
lower back
pain. This is often
worse after exercise especially with extension of the lumbar spine. Other
symptoms include tightness of the hamstrings and decreased range of motion of the
lower back. Some patients can develop pain, numbness, tingling or weakness
in the legs due to nerve compression. Severe compression of the nerves can cause loss of control of
bowel or bladder function, or cauda equina syndrome.
How is spondylolisthesis diagnosed?
In most cases it is not possible to see visible signs of
spondylolisthesis by examining a patient. Patients typically have complaints of
pain in the back with intermittent pain to the legs. Spondylolisthesis can
often cause muscle
spasms, or tightness in the hamstrings.
Spondylolisthesis is easily identified using plain
radiographs. A lateral X-ray (from the side) will show if one of the vertebra
has slipped forward compared to the adjacent vertebrae. Spondylolisthesis is graded according the
percentage of slip of the vertebra compared to the neighboring vertebra.
- Grade I
is a slip of up to 25%,
- grade II is between 26%-50%,
- grade III is between 51%-75%,
- grade IV is between 76% and 100%, and
- Grade V, or spondyloptosis occurs when the
vertebra has completely fallen off the next vertebra.
If the patient has complaints of pain, numbness, tingling
or weakness in the legs, additional studies may be ordered. These symptoms could
be caused by stenosis or narrowing of the space for the nerve roots to the legs.
A CT scan or MRI scan can help identify compression of the nerves associated with
spondylolisthesis. Occasionally, a PET scan can help determine if the bone at
the site of the defect is active. This can play a role in treatment options for
spondylolisthesis as described below.
Next: What is the treatment for spondylolisthesis? »
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