Lumbosacral Spondylolisthesis Clinical Presentation

Updated: Apr 22, 2020
  • Author: Adam E Perrin, MD, FAAFP; Chief Editor: Craig C Young, MD  more...
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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.