Spondylolisthesis is a condition where one vertebral body slides anteriorly over another.
This is generally caused from a genetic defect in the spine and is most commonly seen in children aged between 9-14.
It may also be caused through cases of degeneration such as osteoarthritis or spondylosis.
Cases of isthmic spondylolisthesis may develop following unresolved stress fractures of the lower back although these are less common.
The slips generally occurs low in the lumbar spine at the levels of L5-S1 or L4-L5.
Low grade slippages (grade 1-2) include those with a less than 50% slide over the corresponding vertebrae.
Grade 1 slips may be asymptomatic however patient with grade 2 or higher may complain of low back pain, with or without leg pain.
The pain may be caused by the decrease in the size of the intervertebral foreman or from the increased tension of the annular fibrosis
of the inferior intervertebral disc.
A high grade slippage (grade 3-5) will include movement of greater that 50% over the corresponding vertebrae.
These will frequently be symptomatic and athletes with this grade of spondylolisthesis should avoid high speed or contact sports.
Slippages over 75% that are unstable may require a spinal fusion.
Symptoms of a spondylolisthesis include:
- Lower back pain especially after exercise or periods of lumbar extension/backward bending.
- Aggravation of pain during lumbar extension/bending backwards.
- Flexing of the lower back (bending forward) may decrease the lower back symptoms.
- Muscle tightness/spasm.
- Pain into the thighs or buttocks.
- Some patients may develop tingling, pins and needles, numbness or weakness all signs associated with nerve compression.
Treatment of a spondylolisthesis includes:
- Rest from aggravating factors.
- Improve posture, reduction of lumbar extension.
- Stretching and massage of tight muscles.
- Mobilisations to the thoracic spine which may have stiffened to counter the hyperextension or sway back of the lumbar spine.
- Increase core stability and muscle activation.
- A spinal fusion may be required for a high grade slip that is unstable.
- An athlete may be able to return to sport when they have good spinal stabilisation and can safely move into extension.