eMedicine Specialties > Sports Medicine > Spine

Lumbosacral Spondylolisthesis: Follow-up

Author: Adam E Perrin, MD, FAAFP, Clinical Assistant Professor, Department of Family Medicine, University of Connecticut School of Medicine; Private Practice, Sports and Family Medicine, Credentialed ImPACT Consultant in Acute Concussion Management, Middlesex Health Systems Primary Care, Inc
Coauthor(s): Brian J Shiple, DO, Chief, Director of Primary Care Sport, Department of Family Medicine, Division of Sports Medicine, Clinical Assistant Professor, Crozer-Keystone Health Systems
Contributor Information and Disclosures

Updated: Jun 3, 2008

Follow-up

Return to Play

In general, the athlete is ready to return to play once the following are demonstrated18 :

  • Full, pain-free range of motion
  • Normal strength
  • Appropriate aerobic fitness
  • Adequate spinal awareness and mechanics
  • Performance of sports-related skills without pain

Patients with a slippage equal to or less than grade 1 may resume desired activities once they are asymptomatic. Patients with a grade 2 or greater slippage are generally instructed to avoid hyperextension loading of the spine after symptoms resolve with conservative treatment.

Complications

Possible complications include slippage progression, neurologic deficit, and disc degeneration adjacent to the previously fused segments.

Prevention

Avoiding activities that involve repetitive hyperextension is important for preventing spondylolisthesis. Continuous flexibility and strengthening exercises are recommended to minimize these excessive forces on the lumbosacral spine. If overweight, the athlete is encouraged to achieve his or her ideal weight to reduce stress on the lumbar spine.

Related Medscape topics:
Resource Center Exercise and Sports Medicine
Resource Center Spinal Disorders
Resource Center Weight Management

Prognosis

The prognosis of spondylolisthesis is benign in most cases, and the problem can usually be managed nonoperatively. Surgical correction, when necessary, is usually successful in eliminating symptoms, and the union rate following surgery has been estimated at approximately 75% (depending on the degree of slippage and the surgical technique used).

Education

Patients need to be educated regarding which activities to avoid and which exercises should help minimize the forces that aggravate the condition, and how to identify the typical signs of complications. In their chosen sport, proper technique should be emphasized along with avoidance of abrupt increases in training frequency.

Miscellaneous

Medicolegal Pitfalls

  • Medicolegal issues may arise in cases of missed diagnoses (especially if they result in permanent symptoms), improper treatment, or poor postoperative outcomes.

Related Medscape topic:
Resource Center Medical Malpractice and Legal Issues

 


More on Lumbosacral Spondylolisthesis

Overview: Lumbosacral Spondylolisthesis
Differential Diagnoses & Workup: Lumbosacral Spondylolisthesis
Treatment & Medication: Lumbosacral Spondylolisthesis
Follow-up: Lumbosacral Spondylolisthesis
References
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References

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  3. Lonstein JE. Spondylolisthesis in children. Cause, natural history, and management. Spine. Dec 15 1999;24(24):2640-8. [Medline].

  4. Esses SI, ed. Spondylolisthesis. Textbook of Spinal Disorders. Philadelphia, Pa: Lippincott Williams & Wilkins; 1995:203-13.

  5. Guanciale AF, Dillin WH, Watkins RG. Back pain in children and adolescents. In: Herkowitz HN, Rothman RH, Simeone FA, Balderston RA, eds. The Spine. Vol 1. 4th ed. Philadelphia, Pa: WB Saunders Co; 1999:197-203, 835-85.

  6. Sinaki M, Mokri B. Low back pain and disorders of the lumbar spine. In: Braddom RL, ed. Physical Medicine and Rehabilitation. Philadelphia, Pa: WB Saunders Co; 1996:831-3, 844.

  7. Jackson DW. Low back pain in young athletes: evaluation of stress reaction and discogenic problems. Am J Sports Med. Nov-Dec 1979;7(6):364-6. [Medline].

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  10. Tallarico RA, Madom IA, Palumbo MA. Spondylolysis and spondylolisthesis in the athlete. Sports Med Arthrosc. Mar 2008;16(1):32-8. [Medline].

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  15. Bodner RJ, Heyman S, Drummond DS, Gregg JR. The use of single photon emission computed tomography (SPECT) in the diagnosis of low-back pain in young patients. Spine. Oct 1988;13(10):1155-60. [Medline].

  16. Bell DF, Ehrlich MG, Zaleske DJ. Brace treatment for symptomatic spondylolisthesis. Clin Orthop Relat Res. Nov 1988;236:192-8. [Medline].

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Further Reading

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Keywords

isthmic spondylolisthesis, spondylolysis, hyperextension of the lumbar spine, lumbar spine hyperextension, hyperextended back, hyperextended spine, back pain, lower back pain, low back pain, LBP, spondylolytic spondylolisthesis, lytic spondylolisthesis, pars interarticularis stress fracture, spine stress fracture, Meyerding grading technique, Taillard method, sacral inclination, slip angle

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Contributor Information and Disclosures

Author

Adam E Perrin, MD, FAAFP, Clinical Assistant Professor, Department of Family Medicine, University of Connecticut School of Medicine; Private Practice, Sports and Family Medicine, Credentialed ImPACT Consultant in Acute Concussion Management, Middlesex Health Systems Primary Care, Inc
Adam E Perrin, MD, FAAFP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Family Physicians, American College of Medical Quality, American Medical Society for Sports Medicine, Connecticut State Medical Society, and Society of Teachers of Family Medicine
Disclosure: emedicine Honoraria Independent contractor

Coauthor(s)

Brian J Shiple, DO, Chief, Director of Primary Care Sport, Department of Family Medicine, Division of Sports Medicine, Clinical Assistant Professor, Crozer-Keystone Health Systems
Brian J Shiple, DO is a member of the following medical societies: American Academy of Family Physicians, American College of Physician Executives, American College of Sports Medicine, American Medical Society for Sports Medicine, and American Osteopathic Association
Disclosure: Nothing to disclose.

Medical Editor

Andrew D Perron, MD, Residency Director, Department of Emergency Medicine, Maine Medical Center
Andrew D Perron, MD is a member of the following medical societies: American College of Emergency Physicians, American College of Sports Medicine, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

CME Editor

Jon B Whitehurst, MD, Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner and Executive Board Member, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital
Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

Chief Editor

Craig C Young, MD, Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Sports Medicine Fellowship Director, Medical College of Wisconsin
Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, Phi Beta Kappa, and Wilderness Medical Society
Disclosure: Nothing to disclose.

 
 
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