Spondylolisthesis describes the movement of one vertebral body on another vertebral body below not to be confused with spondylosis (arthritis). The terminology describes the direction of movement, for example anterolisthesis is an anterior or forward shift. There are five types of spondylolisthesis, the two most common and degenerative and isthmic of which degenerative is the most common. Isthmic Spondylolisthesis can be congenital or the result of trauma. The stability of the segments is measured with flexion and extension radiographs and the percentage of slip in graded I- IV. Symptoms are not necessarily correlated with imaging and degree of slippage. It is important to have a thorough neurological exam to rule out any possible worrisome findings such as possible pathological causes of spondylolisthesis affecting the posterior elements. For example, localized bone disease (Paget disease, osteoid osteoma), metastatic tumors (osteolytic lesions) or infection (tuberculosis) that may cause spondylolisthesis.
The prevalence of spondylolisthesis is variable depending on the study, Kettelkamp reported with Caucasians there have been reports of a 6% prevalence and as high as 50% in Alaskan natives. The incidence increase to approximately 35% in those who have a family member with spondylolysis or spondylolisthesis. Spondylolysis is seen in association with Scheuerman’s kyphosis because of the increased lumbar lordosis and excessive shear forces at L5-S1.
According to studies by Herkowitz and Mardjetko the male to female ratio of isthmic spondylolisthesis is 2-4:1. While degenerative spondylolisthesis has been linked to age greater than 50, female (4X more common than males), multiple pregnancies, African American ethnicity (3x more common than Caucasian), generalized laxity of the joints and connective tissue, anatomical predisposition of sagittal facet joints angles and hyperlordosis. If there is sacralized L5 segment the incidence is 4X the expected rate. Heredity is also a major risk factor is with the isthmic variety with contribution from spina bifida.
Degenerative spondylolisthesis and the pain associated is a complex process. The vast majority of degenerative spondylolisthesis cases are not progressive and many surgeons will not attempt to reduce the slippage unless there is significant progression indicating instability, progressive neurological compromise or symptoms there are not improved by conservative options like minimally invasive injections or procedures. Dr. Monreal has completed research on the complexities of spondylolisthesis and the various conservative non-operative interventional pain treatments specifically for spondylolisthesis. Depending on the mechanics of the spine and the type of pain Salem Pain & Spine Specialists can help you determine which treatment is recommended.