Spondylolisthesis

  • Medical Author:
    Catherine Burt Driver, MD

    Catherine Burt Driver, MD, is board certified in internal medicine and rheumatology by the American Board of Internal Medicine. Dr. Driver is a member of the American College of Rheumatology. She currently is in active practice in the field of rheumatology in Mission Viejo, Calif., where she is a partner in Mission Internal Medical Group.

  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

Low Back Pain Relief

What are spondylolisthesis symptoms?

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 stiffness and decreased range of motion of the lower back. Pain in the legs, thighs, and buttocks may worsen with standing. 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.

What types of doctors treat spondylolisthesis?

Radiologists diagnose spondylolisthesis using X-rays, CAT scans, or MRI scans. Orthopedic surgeons, neurosurgeons specializing in the spine, physical medicine and rehabilitation doctors, neurologists, internists, primary-care providers, and rheumatologists commonly treat spondylolisthesis. Chiropractors and physical therapists also frequently treat patients with spondylolisthesis.

How do doctors diagnose spondylolisthesis? How is the grading determined for spondylolisthesis?

Usually, 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.

The diagnosis of spondylolisthesis is easily made 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.

  1. Grade I is a slip of up to 25%.
  2. Grade II is between 26%-50%.
  3. Grade III is between 51%-75%.
  4. Grade IV is between 76%-100%.
  5. 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.

Medically Reviewed by a Doctor on 7/20/2016

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