History

Patients with spondylolisthesis are usually asymptomatic. The onset typically occurs during the growth spurt in late childhood and early adolescence, probably because of increased participation in strenuous sports during this period. Spondylolisthesis is an unlikely cause of back pain in adults (especially after age 40 years) with no history of symptoms before age 30 years; typically, another cause is identified (eg, disc injury, strain).

Low back pain is the most frequently reported symptom, and it is often exacerbated by motion, particularly lumbar extension and twisting. Radiation of pain into the buttocks is not uncommon. The patient may report relief of pain with extended periods of rest. Rarely, associated leg pain is present in the L5 or S1 distribution as a result of nerve root compression. Symptoms are often more severe during the advanced months of pregnancy.

Physical Examination

Findings noted during the physical examination may include the following:

With high-grade slips, a palpable step-off may be felt over the spinous process at the level above the slipped vertebra because the posterior arch of the forward translated vertebra remains in place.^[15]
Tenderness to deep palpation of the spinous process above the slip (typically L4) may be present. This palpation occasionally causes radicular pain.
A positive one-leg hyperextension test (stork test) suggests a diagnosis of spondylolysis, but it is a nonspecific test with low sensitivity^[16]and low specificity.^[17]
Hamstring tightness that is associated with all grades of symptomatic spondylolisthesis occurs at a rate of 80%. It commonly results in an abnormal gait, typically waddlelike, due to the inability of the patient to flex the hip with the knees extended.
Paraspinal muscle spasm and tenderness are usually present.
In advanced cases, a relatively short torso with a low rib cage, high iliac crests, and heart-shaped buttocks are noted.
Limited forward flexion of the trunk is common with reduced straight-leg raising, which may cause pain but rarely any signs of nerve root tension.
Postural deformity and a transverse abdominal crease are seen as a result of the pelvis being thrust forward.
A thorough neurologic evaluation should be performed, including sensation in the sacral region to check for cauda equina compression.
Weakness in the tibialis anterior muscle (L4 nerve root) is common.

Differential Diagnoses

Gagnet P, Kern K, Andrews K, Elgafy H, Ebraheim N. Spondylolysis and spondylolisthesis: a review of the literature. J Orthop. 2018 Jun. 15 (2):404-7. [QxMD MEDLINE Link].
Kalichman L, Hunter DJ. Diagnosis and conservative management of degenerative lumbar spondylolisthesis. Eur Spine J. 2008 Mar. 17(3):327-35. [QxMD MEDLINE Link]. [Full Text].
Metz LN, Deviren V. Low-grade spondylolisthesis. Neurosurg Clin N Am. 2007 Apr. 18(2):237-48. [QxMD MEDLINE Link].
Lonstein JE. Spondylolisthesis in children. Cause, natural history, and management. Spine. 1999 Dec 15. 24(24):2640-8. [QxMD MEDLINE Link].
Esses SI ed. Spondylolisthesis. Textbook of Spinal Disorders. Philadelphia, Pa: Lippincott Williams & Wilkins; 1995. 203-13.
Guanciale AF, Dillin WH, Watkins RG. Back pain in children and adolescents. Herkowitz HN, Rothman RH, Simeone FA, Balderston RA, eds. The Spine. 4th ed. Philadelphia, Pa: WB Saunders Co; 1999. Vol 1: 197-203, 835-85.
Sinaki M, Mokri B. Low back pain and disorders of the lumbar spine. Braddom RL, ed. Physical Medicine and Rehabilitation. Philadelphia, Pa: WB Saunders Co; 1996. 831-3, 844.
Smith JA, Hu SS. Management of spondylolysis and spondylolisthesis in the pediatric and adolescent population. Orthop Clin North Am. 1999 Jul. 30(3):487-99, ix. [QxMD MEDLINE Link].
Mac-Thiong JM, Duong L, Parent S, et al. Reliability of the Spinal Deformity Study Group classification of lumbosacral spondylolisthesis. Spine (Phila Pa 1976). 2012 Jan 15. 37 (2):E95-102. [QxMD MEDLINE Link].
Tallarico RA, Madom IA, Palumbo MA. Spondylolysis and spondylolisthesis in the athlete. Sports Med Arthrosc. 2008 Mar. 16(1):32-8. [QxMD MEDLINE Link].
Congeni J, McCulloch J, Swanson K. Lumbar spondylolysis. A study of natural progression in athletes. Am J Sports Med. 1997 Mar-Apr. 25(2):248-53. [QxMD MEDLINE Link].
Danielson BI, Frennered AK, Irstam LK. Radiologic progression of isthmic lumbar spondylolisthesis in young patients. Spine (Phila Pa 1976). 1991 Apr. 16(4):422-5. [QxMD MEDLINE Link].
Kalichman L, Kim DH, Li L, Guermazi A, Berkin V, Hunter DJ. Spondylolysis and spondylolisthesis: prevalence and association with low back pain in the adult community-based population. Spine (Phila Pa 1976). 2009 Jan 15. 34 (2):199-205. [QxMD MEDLINE Link].
de Schepper EI, Koes BW, Veldhuizen EF, Oei EH, Bierma-Zeinstra SM, Luijsterburg PA. Prevalence of spinal pathology in patients presenting for lumbar MRI as referred from general practice. Fam Pract. 2016 Feb. 33 (1):51-6. [QxMD MEDLINE Link].
Grødahl LH, Fawcett L, Nazareth M, et al. Diagnostic utility of patient history and physical examination data to detect spondylolysis and spondylolisthesis in athletes with low back pain: A systematic review. Man Ther. 2016 Aug. 24:7-17. [QxMD MEDLINE Link].
Sundell CG, Jonsson H, Adin L, Larsen KH. Clinical examination, spondylolysis and adolescent athletes. Int J Sports Med. 2013 Mar. 34(3):263-7. [QxMD MEDLINE Link].
Masci L, Pike J, Malara F, Phillips B, Bennell K, Brukner P. Use of the one-legged hyperextension test and magnetic resonance imaging in the diagnosis of active spondylolysis. Br J Sports Med. 2006 Nov. 40(11):940-6; discussion 946. [QxMD MEDLINE Link].
Foreman P, Griessenauer CJ, Watanabe K, Conklin M, Shoja MM, Rozzelle CJ. L5 spondylolysis/spondylolisthesis: a comprehensive review with an anatomic focus. Childs Nerv Syst. 2013 Feb. 29(2):209-16. [QxMD MEDLINE Link].
Seitsalo S, Osterman K, Hyvarinen H, Tallroth K, Schlenzka D, Poussa M. Progression of spondylolisthesis in children and adolescents. A long-term follow-up of 272 patients. Spine. 1991 Apr. 16(4):417-21. [QxMD MEDLINE Link].
Lusins JO, Elting JJ, Cicoria AD, Goldsmith SJ. SPECT evaluation of lumbar spondylolysis and spondylolisthesis. Spine. 1994 Mar 1. 19(5):608-12. [QxMD MEDLINE Link].
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. 1988 Oct. 13(10):1155-60. [QxMD MEDLINE Link].
Bell DF, Ehrlich MG, Zaleske DJ. Brace treatment for symptomatic spondylolisthesis. Clin Orthop Relat Res. 1988 Nov. 192-8. [QxMD MEDLINE Link].
Majid K, Fischgrund JS. Degenerative lumbar spondylolisthesis: trends in management. J Am Acad Orthop Surg. 2008 Apr. 16(4):208-15. [QxMD MEDLINE Link].
Kobayashi A, Kobayashi T, Kato K, Higuchi H, Takagishi K. Diagnosis of radiographically occult lumbar spondylolysis in young athletes by magnetic resonance imaging. Am J Sports Med. 2013 Jan. 41(1):169-76. [QxMD MEDLINE Link].
Gerszten PC, Tobler W, Raley TJ, Miller LE, Block JE, Nasca RJ. Axial presacral lumbar interbody fusion and percutaneous posterior fixation for stabilization of lumbosacral isthmic spondylolisthesis. J Spinal Disord Tech. 2012 Apr. 25 (2):E36-40. [QxMD MEDLINE Link].
Tender GC, Miller LE, Block JE. Percutaneous pedicle screw reduction and axial presacral lumbar interbody fusion for treatment of lumbosacral spondylolisthesis: A case series. J Med Case Reports. 2011 Sep 12. 5:454. [QxMD MEDLINE Link]. [Full Text].
Eddy D, Congeni J, Loud K. A review of spine injuries and return to play. Clin J Sport Med. 2005 Nov. 15(6):453-8. [QxMD MEDLINE Link].
Hresko MT, Labelle H, Roussouly P, Berthonnaud E. Classification of high-grade spondylolistheses based on pelvic version and spine balance: possible rationale for reduction. Spine. 2007 Sep 15. 32(20):2208-13. [QxMD MEDLINE Link].
Lonner BS, Song EW, Scharf CL, Yao J. Reduction of high-grade isthmic and dysplastic spondylolisthesis in 5 adolescents. Am J Orthop (Belle Mead NJ). 2007 Jul. 36(7):367-73. [QxMD MEDLINE Link].

Media Gallery

of 0

Lumbosacral Spondylolisthesis Clinical Presentation

History

Physical Examination

References

Tables

Contributor Information and Disclosures

What would you like to print?