Lumbar Spondylolysis and Spondylolisthesis Follow-up

  • Author: Beth B Froese, MD; Chief Editor: Rene Cailliet, MD   more...
 
Updated: Jan 18, 2012
 

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.
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Inpatient & Outpatient Medications

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

  • Prevention of isthmic spondylolisthesis may be difficult in athletes who must perform repetitive activities requiring hyperextension.[11] The best prevention is to avoid repetitive hyperextension if at all possible, since this activity appears to place athletes at the greatest risk.
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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.
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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.
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Patient Education

  • Athletes involved in higher risk sports should be educated about the risk of developing a spondylolysis.[6, 7, 8, 10, 11, 9]
  • Instruction regarding an appropriate home exercise program, including a flexion-based spine exercise protocol and hamstring stretching, should be a part of treatment.
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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.

Specialty Editor Board

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.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Patrick M Foye, MD  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 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.

Kelly L Allen, MD  Medical Director, Medevals

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.

References

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Radiograph of the lumbosacral junction showing a grade 1 spondylolytic spondylolisthesis at L5-S1.
Lumbar oblique radiograph showing the "Scottie Dog." A pars defect is seen at L5.
Bone scan with single-photon emission computed tomography (SPECT) imaging showing acute spondylolysis
Axial computed tomography (CT) scan shows bilateral spondylolysis. Note elongation of the spinal canal at this level.
Grade 4 traumatic spondylolisthesis.
Diagram in the oblique projection shows the components of the vertebrae that result in the appearance of a Scottie dog with a collar.
 
 
 
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