eMedicine Specialties > Physical Medicine and Rehabilitation > Lumbar Spine Disorders

Lumbar Spondylolysis and Spondylolisthesis: Follow-up

Author: Beth B Froese, MD, Consulting Staff, Department of Physical Medicine and Rehabilitation, Orthopaedic Associates of DuPage Ltd
Contributor Information and Disclosures

Updated: Jul 5, 2009

Follow-up

Further Outpatient Care

  • Because risk of progression exists in younger patients with isthmic or congenital spondylolisthesis, obtain serial radiographs on a semiannual basis to rule out the possibility of progression if symptoms are persistent.

Inpatient & Outpatient Medications

  • Anti-inflammatories and other analgesics are the only medications used in the care of patients with spondylolysis or spondylolisthesis.

Deterrence

  • Prevention of isthmic spondylolisthesis may be difficult in athletes who must perform repetitive activities requiring hyperextension.10 The best prevention is to avoid repetitive hyperextension if at all possible, since this activity appears to place athletes at the greatest risk.

Complications

  • The most common complication of spondylolisthesis of any type is nerve root impingement/radiculopathy at the level of spondylolisthesis. Spinal stenosis and cauda equina syndrome may occur when a significant slip has occurred.
  • Disk degeneration occurs at the level of the spondylolisthesis faster than at other levels of the spine, increasing the risk of diskogenic low back pain.

Prognosis

  • In general, patients with grade 1 or grade 2 isthmic slips do quite well with conservative management. Patients may return to play once they are asymptomatic. A flexion-based home exercise protocol is vital. Overall long-term outcome is quite favorable, specifically with lower grades of listhesis not accompanied by neurologic impairment.
  • Higher grades of isthmic spondylolisthesis have a variable prognosis with regard to persistent low back pain. Surgical intervention does provide nice improvement in claudication or radicular symptoms. Diskogenic pain may produce more persistent lower lumbar discomfort.
  • Patients with degenerative spondylolisthesis seem to have persistent waxing and waning pain originating from the facet joints. Surgical decompression for neurologic compromise has a high rate of success in relieving lower extremity symptoms.

Patient Education

  • Athletes involved in higher risk sports should be educated about the risk of developing a spondylolysis.5,6,7,9,10,8
  • Instruction regarding an appropriate home exercise program, including a flexion-based spine exercise protocol and hamstring stretching, should be a part of treatment.

Miscellaneous

Medicolegal Pitfalls

  • Perhaps the most frightening legal pitfall is failure to diagnose a more serious cause of low back pain in a young patient. A positive bone scan is not a specific test and may indicate presence of malignancy. The physician should be prudent and order thin cut CT scan or MRI if the patient does not improve with interventions discussed above.
 


More on Lumbar Spondylolysis and Spondylolisthesis

Overview: Lumbar Spondylolysis and Spondylolisthesis
Differential Diagnoses & Workup: Lumbar Spondylolysis and Spondylolisthesis
Treatment & Medication: Lumbar Spondylolysis and Spondylolisthesis
Follow-up: Lumbar Spondylolysis and Spondylolisthesis
Multimedia: Lumbar Spondylolysis and Spondylolisthesis
References
Further Reading
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References

  1. Wiltse LL. Spondylolisthesis: classification and etiology. Symposium of the Spine. Am Acad Orthop Surg. 1969;143.

  2. Grobler LJ, Wiltse LL. Classification, and nonoperative and operative treatment of spondylolisthesis. In: Frymoyer's The Adult Spine: Principles and Practice. 2nd ed. Philadelphia, Pa: Lippincott; 1997:1865-921.

  3. Huang KY, Lin RM, Lee YL, et al. Factors affecting disability and physical function in degenerative lumbar spondylolisthesis of L4-5: evaluation with axially loaded MRI. Eur Spine J. Jun 14 2009;[Medline].

  4. Beutler WJ, Fredrickson BE, Murtland A, et al. The natural history of spondylolysis and spondylolisthesis: 45-year follow-up evaluation. Spine. May 15 2003;28(10):1027-35; discussion 1035. [Medline].

  5. d'Hemecourt PA, Gerbino PG, Micheli LJ. Back injuries in the young athlete. Clin Sports Med. Oct 2000;19(4):663-79. [Medline].

  6. Comstock CP, Carragee EJ, O'Sullivan GS. Spondylolisthesis in the young athlete. The Physician and Sportsmedicine. 1994;22(12):39-46.

  7. Rossi F. Spondylolysis, spondylolisthesis and sports. J Sports Med Phys Fitness. Dec 1978;18(4):317-40. [Medline].

  8. Sairyo K, Katoh S, Sasa T, et al. Athletes with unilateral spondylolysis are at risk of stress fracture at the contralateral pedicle and pars interarticularis: a clinical and biomechanical study. Am J Sports Med. Apr 2005;33(4):583-90. [Medline].

  9. Kruse D, Lemmen B. Spine injuries in the sport of gymnastics. Curr Sports Med Rep. Jan-Feb 2009;8(1):20-8. [Medline].

  10. Bono CM. Low-back pain in athletes. J Bone Joint Surg Am. Feb 2004;86-A(2):382-96. [Medline].

  11. Peterson JB, Wenger DR. Asymmetric spondylolisthesis as the cause of childhood lumbar scoliosis--can new imaging modalities help clarify the relationship?. Iowa Orthop J. 2008;28:65-72. [Medline]. [Full Text].

  12. Wynne-Davies R, Scott JH. Inheritance and spondylolisthesis: a radiographic family survey. J Bone Joint Surg [Br]. Aug 1979;61-B(3):301-5. [Medline]. [Full Text].

  13. Sairyo K, Sakai T, Yasui N. Conservative treatment of lumbar spondylolysis in childhood and adolescence: the radiological signs which predict healing. J Bone Joint Surg Br. Feb 2009;91(2):206-9. [Medline].

  14. Smith JA, Hu SS. Management of spondylolysis and spondylolisthesis in the pediatric and adolescent population. Orthop Clin North Am. Jul 1999;30(3):487-99, ix. [Medline].

  15. Steiner ME, Micheli LJ. Treatment of symptomatic spondylolysis and spondylolisthesis with the modified Boston brace. Spine. Dec 1985;10(10):937-43. [Medline].

  16. [Best Evidence] Matsudaira K, Seichi A, Kunogi J, et al. The efficacy of prostaglandin E1 derivative in patients with lumbar spinal stenosis. Spine. Jan 15 2009;34(2):115-20. [Medline].

  17. Magee DJ. Orthopedic Physical Assessment. Philadelphia, Pa: WB Saunders; 1997:. 398.

  18. McGregor AH, Cattermole HR, Hughes SP. Global spinal motion in subjects with lumbar spondylolysis and spondylolisthesis: does the grade or type of slip affect global spinal motion?. Spine. Feb 1 2001;26(3):282-6. [Medline].

  19. Rothman RH, Simeone FA. Spondylolisthesis. vol 1. 1992:913-69.

  20. Simper LB. Spondylolysis in Eskimo skeletons. Acta Orthop Scand. Feb 1986;57(1):78-80. [Medline].

  21. Standaert CJ, Herring SA, Halpern B, King O. Spondylolysis. Phys Med Rehabil Clin N Am. Nov 2000;11(4):785-803. [Medline].

  22. Weinstein JN, Rydevik BL, Sonntag VKH, eds. Essentials of the Spine. New York, NY: Raven Press; 1995:. 195-230.

  23. Whitesides TE Jr, Horton WC, Hutton WC, et al. Spondylolytic spondylolisthesis: a study of pelvic and lumbosacral parameters of possible etiologic effect in two genetically and geographically distinct groups with high occurrence. Spine. Mar 15 2005;30(6 Suppl):S12-21. [Medline].

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Contributor Information and Disclosures

Author

Beth B Froese, MD, Consulting Staff, Department of Physical Medicine and Rehabilitation, Orthopaedic Associates of DuPage Ltd
Beth B Froese, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Medical Association, and Illinois State Medical Society
Disclosure: Nothing to disclose.

Medical Editor

Curtis W Slipman, MD, Director, University of Pennsylvania Spine Center; Associate Professor, Department of Physical Medicine and Rehabilitation, University of Pennsylvania Medical Center
Curtis W Slipman, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Association of Academic Physiatrists, International Association for the Study of Pain, and North American Spine Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Patrick M Foye, MD, FAAPMR, FAAEM, Associate Professor of Physical Medicine and Rehabilitation, Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, Director of Coccyx Pain Service (Tailbone Pain Service: www.TailboneDoctor.com), University of Medicine and Dentistry of New Jersey, New Jersey Medical School
Patrick M Foye, MD, FAAPMR, FAAEM is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, Association of Academic Physiatrists, and International Spine Intervention Society
Disclosure: Nothing to disclose.

CME Editor

Kelly L Allen, MD, Regional Medical Director, IMX-Medical Management Services
Disclosure: Nothing to disclose.

Chief Editor

Rene Cailliet, MD, Professor-Chairman Emeritus, Department of Rehabilitation Medicine, University of Southern California School of Medicine; Former Director, Department of Rehabilitation Medicine, Santa Monica Hospital Medical Center
Rene Cailliet, MD is a member of the following medical societies: American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American Pain Society, Association of American Medical Colleges, International Association for the Study of Pain, and Pan American Medical Association
Disclosure: Nothing to disclose.

 
 
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