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Spondylolisthesis pp 43–57Cite as

Clinical Evaluation of Adult Patient with Spondylolisthesis

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Abstract

Adult spondylolisthesis is the translation of one vertebra in relation to the adjacent level and can be classified into six groups: dysplastic, isthmic, degenerative, traumatic, pathologic, and post-surgical. This chapter reviews the clinical presentation and evaluation of patients with spondylolisthesis.

Patients will commonly present with lower back pain. Low back pain may be positional, worsening with extension or flexion. Radicular pain or symptoms of neurogenic claudication are also commonly present. Younger patients may be more likely to present with an isthmic spondylolisthesis, while older patients, especially females, are likely to present with a degenerative spondylolisthesis.

Physical examination includes an assessment of lumbar range of motion, areas of tenderness to palpation and, most importantly, a thorough neurological examination.

Symptomatic patients can be evaluated with upright static and dynamic radiographs of the lumbar spine as well as full-length radiographs to assess the spondylolisthetic segment as well as sagittal balance. Advanced imaging, most commonly magnetic resonance imaging, can be beneficial to confirm the presence and location of nerve root compression.

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References

  1. Wiltse LL, Newman PH, Macnab I. Classification of spondylolisis and spondylolisthesis. Clin Orthop Relat Res. 1976;117:23–9.

    PubMed  Google Scholar 

  2. Farfan HF, Osteria V, Lamy C. The mechanical etiology of spondylolysis and spondylolisthesis. Clin Orthop Relat Res. 1976;117:40–55.

    PubMed  Google Scholar 

  3. Wiltse LL, Widell Jr EH, Jackson DW. Fatigue fracture: the basic lesion is inthmic spondylolisthesis. J Bone Joint Surg Am. 1975;57(1):17–22.

    CAS  PubMed  Google Scholar 

  4. Ferguson RJ, McMaster JH, Stanitski CL. Low back pain in college football linemen. J Sports Med. 1974;2(2):63–9.

    Article  CAS  PubMed  Google Scholar 

  5. Jackson DW, Wiltse LL, Cirincoine RJ. Spondylolysis in the female gymnast. Clin Orthop Relat Res. 1976;117:68–73.

    PubMed  Google Scholar 

  6. Roussouly P, Gollogly S, Berthonnaud E, Labelle H, Weidenbaum M. Sagittal alignment of the spine and pelvis in the presence of L5-s1 isthmic lysis and low-grade spondylolisthesis. Spine (Phila Pa 1976). 2006;31(21):2484–90.

    Article  Google Scholar 

  7. Labelle H, Mac-Thiong JM, Roussouly P. Spino-pelvic sagittal balance of spondylolisthesis: a review and classification. Eur Spine J. 2011;20 Suppl 5:641–6.

    Article  PubMed Central  PubMed  Google Scholar 

  8. McGuire Jr R. Adult isthmic spondylolisthesis. In: Harry N, Herkowitz SRG, Eismont FJ, Bell GR, Balderston R, editors. Rothman-Simeone the spine, vol. 2. Philadelphia: Elsevier Saunders; 2011. p. 1254–62.

    Chapter  Google Scholar 

  9. Hu SS, Tribus CB, Diab M, Ghanayem AJ. Spondylolisthesis and spondylolysis. J Bone Joint Surg Am. 2008;90(3):656–71.

    PubMed  Google Scholar 

  10. Ganju A. Isthmic spondylolisthesis. Neurosurg Focus. 2002;13(1):E1.

    Article  PubMed  Google Scholar 

  11. Meyerding H. Spondylolisthesis. Surg Gynecol Obstet. 1932;54:371–7.

    Google Scholar 

  12. Marchetti P, Bartolozzi P. Classification of spondylolisthesis as a guideline for treatment. In: Bridwell K, DeWald R, Hammerberg K, et al., editors. The textbook of spinal surgery. 2nd ed. Philadelphia: Lippincott-Raven; 1997. p. 1211–54.

    Google Scholar 

  13. Fredrickson BE, Baker D, McHolick WJ, Yuan HA, Lubicky JP. The natural history of spondylolysis and spondylolisthesis. J Bone Joint Surg Am. 1984;66(5):699–707.

    CAS  PubMed  Google Scholar 

  14. 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;34(2):199–205.

    Article  Google Scholar 

  15. Beutler WJ, Fredrickson BE, Murtland A, Sweeney CA, Grant WD, Baker D. The natural history of spondylolysis and spondylolisthesis: 45-year follow-up evaluation. Spine (Phila Pa 1976). 2003;28(10):1027–35. discussion 1035.

    Google Scholar 

  16. Roche MB, Rowe GG. The incidence of separate neural arch and coincident bone variations; a summary. J Bone Joint Surg Am. 1952;34-A(2):491–4.

    CAS  PubMed  Google Scholar 

  17. Stewart TD. The age incidence of neural-arch defects in Alaskan natives, considered from the standpoint of etiology. J Bone Joint Surg Am. 1953;35-A(4):937–50.

    CAS  PubMed  Google Scholar 

  18. Saraste H. Symptoms in relation to the level of spondylolysis. Int Orthop. 1986;10(3):183–5.

    CAS  PubMed  Google Scholar 

  19. Saraste H. Long-term clinical and radiological follow-up of spondylolysis and spondylolisthesis. J Pediatr Orthop. 1987;7(6):631–8.

    Article  CAS  PubMed  Google Scholar 

  20. Jones TR, Rao RD. Adult isthmic spondylolisthesis. J Am Acad Orthop Surg. 2009;17(10):609–17.

    PubMed  Google Scholar 

  21. Edelson JG, Nathan H. Nerve root compression in spondylolysis and spondylolisthesis. J Bone Joint Surg Br. 1986;68(4):596–9.

    CAS  PubMed  Google Scholar 

  22. Jinkins JR, Rauch A. Magnetic resonance imaging of entrapment of lumbar nerve roots in spondylolytic spondylolisthesis. J Bone Joint Surg Am. 1994;76(11):1643–8.

    CAS  PubMed  Google Scholar 

  23. Wiltse LL, Guyer RD, Spencer CW, Glenn WV, Porter IS. Alar transverse process impingement of the L5 spinal nerve: the far-out syndrome. Spine (Phila Pa 1976). 1984;9(1):31–41.

    Article  CAS  Google Scholar 

  24. Moller H, Sundin A, Hedlund R. Symptoms, signs, and functional disability in adult spondylolisthesis. Spine (Phila Pa 1976). 2000;25(6):683–9. discussion 690.

    Article  CAS  Google Scholar 

  25. Beck NA, Miller R, Baldwin K, et al. Do oblique views add value in the diagnosis of spondylolysis in adolescents? J Bone Joint Surg Am. 2013;95(10):e651–7.

    Article  Google Scholar 

  26. Boxall D, Bradford DS, Winter RB, Moe JH. Management of severe spondylolisthesis in children and adolescents. J Bone Joint Surg Am. 1979;61(4):479–95.

    CAS  PubMed  Google Scholar 

  27. Grobler LJ, Novotny JE, Wilder DG, Frymoyer JW, Pope MH. L4-5 isthmic spondylolisthesis. A biomechanical analysis comparing stability in L4-5 and L5-S1 isthmic spondylolisthesis. Spine (Phila Pa 1976). 1994;19(2):222–7.

    Article  CAS  Google Scholar 

  28. 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 (Phila Pa 1976). 1991;16(4):417–21.

    Article  CAS  Google Scholar 

  29. Wiltse LL, Winter RB. Terminology and measurement of spondylolisthesis. J Bone Joint Surg Am. 1983;65(6):768–72.

    CAS  PubMed  Google Scholar 

  30. Antoniades SB, Hammerberg KW, DeWald RL. Sagittal plane configuration of the sacrum in spondylolisthesis. Spine (Phila Pa 1976). 2000;25(9):1085–91.

    Article  CAS  Google Scholar 

  31. Laurent LE, Einola S. Spondylolisthesis in children and adolescents. Acta Orthop Scand. 1961;31:45–64.

    Article  CAS  PubMed  Google Scholar 

  32. Slim GP. Vertebral contour in spondylolisthesis. Br J Radiol. 1973;46(544):250–4.

    Article  CAS  PubMed  Google Scholar 

  33. Yue WM, Brodner W, Gaines RW. Abnormal spinal anatomy in 27 cases of surgically corrected spondyloptosis: proximal sacral endplate damage as a possible cause of spondyloptosis. Spine (Phila Pa 1976). 2005;30(6 Suppl):S22–6.

    Article  Google Scholar 

  34. Vialle R, Levassor N, Rillardon L, Templier A, Skalli W, Guigui P. Radiographic analysis of the sagittal alignment and balance of the spine in asymptomatic subjects. J Bone Joint Surg Am. 2005;87(2):260–7.

    Article  PubMed  Google Scholar 

  35. Vaz G, Roussouly P, Berthonnaud E, Dimnet J. Sagittal morphology and equilibrium of pelvis and spine. Eur Spine J. 2002;11(1):80–7.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  36. Lafage V, Schwab F, Patel A, Hawkinson N, Farcy JP. Pelvic tilt and truncal inclination: two key radiographic parameters in the setting of adults with spinal deformity. Spine (Phila Pa 1976). 2009;34(17):E599–606.

    Article  Google Scholar 

  37. Glassman SD, Bridwell K, Dimar JR, Horton W, Berven S, Schwab F. The impact of positive sagittal balance in adult spinal deformity. Spine (Phila Pa 1976). 2005;30(18):2024–9.

    Article  Google Scholar 

  38. Schwab F, Patel A, Ungar B, Farcy JP, Lafage V. Adult spinal deformity-postoperative standing imbalance: how much can you tolerate? An overview of key parameters in assessing alignment and planning corrective surgery. Spine (Phila Pa 1976). 2010;35(25):2224–31.

    Article  Google Scholar 

  39. Duval-Beaupere G, Schmidt C, Cosson P. A Barycentremetric study of the sagittal shape of spine and pelvis: the conditions required for an economic standing position. Ann Biomed Eng. 1992;20(4):451–62.

    Article  CAS  PubMed  Google Scholar 

  40. Hanson DS, Bridwell KH, Rhee JM, Lenke LG. Correlation of pelvic incidence with low- and high-grade isthmic spondylolisthesis. Spine (Phila Pa 1976). 2002;27(18):2026–9.

    Article  Google Scholar 

  41. Li Y, Hresko MT. Radiographic analysis of spondylolisthesis and sagittal spinopelvic deformity. J Am Acad Orthop Surg. 2012;20(4):194–205.

    Article  PubMed  Google Scholar 

  42. Mac-Thiong JM, Berthonnaud E, Dimar 2nd JR, Betz RR, Labelle H. Sagittal alignment of the spine and pelvis during growth. Spine (Phila Pa 1976). 2004;29(15):1642–7.

    Article  Google Scholar 

  43. Huang RP, Bohlman HH, Thompson GH, Poe-Kochert C. Predictive value of pelvic incidence in progression of spondylolisthesis. Spine (Phila Pa 1976). 2003;28(20):2381–5. discussion 2385.

    Article  Google Scholar 

  44. Mac-Thiong JM, Transfeldt EE, Mehbod AA, et al. Can C7 plumbline and gravity line predict health related quality of life in adult scoliosis? Spine (Phila Pa 1976). 2009;34(15):E519–27.

    Article  Google Scholar 

  45. Harroud A, Labelle H, Joncas J, Mac-Thiong JM. Global sagittal alignment and health-related quality of life in lumbosacral spondylolisthesis. Eur Spine J. 2013;22(4):849–56.

    Article  PubMed Central  PubMed  Google Scholar 

  46. Jackson RP, Phipps T, Hales C, Surber J. Pelvic lordosis and alignment in spondylolisthesis. Spine (Phila Pa 1976). 2003;28(2):151–60.

    Article  Google Scholar 

  47. Mac-Thiong JM, Wang Z, de Guise JA, Labelle H. Postural model of sagittal spino-pelvic alignment and its relevance for lumbosacral developmental spondylolisthesis. Spine (Phila Pa 1976). 2008;33(21):2316–25.

    Article  Google Scholar 

  48. Labelle H, Roussouly P, Berthonnaud E, Dimnet J, O'Brien M. The importance of spino-pelvic balance in L5-s1 developmental spondylolisthesis: a review of pertinent radiologic measurements. Spine (Phila Pa 1976). 2005;30(6 Suppl):S27–34.

    Article  Google Scholar 

  49. 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 (Phila Pa 1976). 2007;32(20):2208–13.

    Article  Google Scholar 

  50. Stagnara P, De Mauroy JC, Dran G, et al. Reciprocal angulation of vertebral bodies in a sagittal plane: approach to references for the evaluation of kyphosis and lordosis. Spine (Phila Pa 1976). 1982;7(4):335–42.

    Article  CAS  Google Scholar 

  51. Kirkaldy-Willis W. Presidential symposium on instability of the lumbar spine. Spine (Phila Pa 1976). 1985;10:254.

    Article  Google Scholar 

  52. Grobler LJ, Robertson PA, Novotny JE, Pope MH. Etiology of spondylolisthesis. Assessment of the role played by lumbar facet joint morphology. Spine (Phila Pa 1976). 1993;18(1):80–91.

    Article  CAS  Google Scholar 

  53. Rosenberg NJ. Degenerative spondylolisthesis. Predisposing factors. J Bone Joint Surg Am. 1975;57(4):467–74.

    CAS  PubMed  Google Scholar 

  54. Jacobsen S, Sonne-Holm S, Rovsing H, Monrad H, Gebuhr P. Degenerative lumbar spondylolisthesis: an epidemiological perspective: the Copenhagen Osteoarthritis Study. Spine (Phila Pa 1976). 2007;32(1):120–5.

    Article  Google Scholar 

  55. Ha KY, Chang CH, Kim KW, Kim YS, Na KH, Lee JS. Expression of estrogen receptor of the facet joints in degenerative spondylolisthesis. Spine (Phila Pa 1976). 2005;30(5):562–6.

    Article  Google Scholar 

  56. Bird HA, Eastmond CJ, Hudson A, Wright V. Is generalized joint laxity a factor in spondylolisthesis? Scand J Rheumatol. 1980;9(4):203–5.

    Article  CAS  PubMed  Google Scholar 

  57. Vibert BT, Sliva CD, Herkowitz HN. Treatment of instability and spondylolisthesis: surgical versus nonsurgical treatment. Clin Orthop Relat Res. 2006;443:222–7.

    Article  PubMed  Google Scholar 

  58. Majid K, Fischgrund JS. Degenerative lumbar spondylolisthesis: trends in management. J Am Acad Orthop Surg. 2008;16(4):208–15.

    PubMed  Google Scholar 

  59. Bell GR. Degenerative spondylolisthesis. In: Harry N, Herkowitz SRG, Eismont FJ, Bell GR, Balderston R, editors. Rothman-Simeone the spine, vol. 2. Philadelphia: Elsevier Saunders; 2011. p. 1101–17.

    Chapter  Google Scholar 

  60. Matsunaga S, Ijiri K, Hayashi K. Nonsurgically managed patients with degenerative spondylolisthesis: a 10- to 18-year follow-up study. J Neurosurg. 2000;93(2 Suppl):194–8.

    CAS  PubMed  Google Scholar 

  61. Verbiest H. A radicular syndrome from developmental narrowing of the lumbar vertebral canal. J Bone Joint Surg Br. 1954;36-B(2):230–7.

    CAS  PubMed  Google Scholar 

  62. Katz JN, Dalgas M, Stucki G, et al. Degenerative lumbar spinal stenosis. Diagnostic value of the history and physical examination. Arthritis Rheum. 1995;38(9):1236–41.

    Article  CAS  PubMed  Google Scholar 

  63. Inufusa A, An HS, Lim TH, Hasegawa T, Haughton VM, Nowicki BH. Anatomic changes of the spinal canal and intervertebral foramen associated with flexion-extension movement. Spine (Phila Pa 1976). 1996;21(21):2412–20.

    Article  CAS  Google Scholar 

  64. Jonsson B, Stromqvist B. Symptoms and signs in degeneration of the lumbar spine. A prospective, consecutive study of 300 operated patients. J Bone Joint Surg Br. 1993;75(3):381–5.

    CAS  PubMed  Google Scholar 

  65. Bendo JA, Ong B. Importance of correlating static and dynamic imaging studies in diagnosing degenerative lumbar spondylolisthesis. Am J Orthop (Belle Mead NJ). 2001;30(3):247–50.

    CAS  Google Scholar 

  66. Chaput C, Padon D, Rush J, Lenehan E, Rahm M. The significance of increased fluid signal on magnetic resonance imaging in lumbar facets in relationship to degenerative spondylolisthesis. Spine (Phila Pa 1976). 2007;32(17):1883–7.

    Article  Google Scholar 

  67. Boden SD, Wiesel SW. Lumbosacral segmental motion in normal individuals. Have we been measuring instability properly? Spine (Phila Pa 1976). 1990;15(6):571–6.

    Article  CAS  Google Scholar 

  68. Hayes MA, Howard TC, Gruel CR, Kopta JA. Roentgenographic evaluation of lumbar spine flexion-extension in asymptomatic individuals. Spine (Phila Pa 1976). 1989;14(3):327–31.

    Article  CAS  Google Scholar 

  69. Lattig F, Fekete TF, Grob D, Kleinstuck FS, Jeszenszky D, Mannion AF. Lumbar facet joint effusion in MRI: a sign of instability in degenerative spondylolisthesis? Eur Spine J. 2012;21(2):276–81.

    Article  PubMed Central  PubMed  Google Scholar 

  70. Ben-Galim P, Reitman CA. The distended facet sign: an indicator of position-dependent spinal stenosis and degenerative spondylolisthesis. Spine J. 2007;7(2):245–8.

    Article  PubMed  Google Scholar 

  71. Oishi Y, Murase M, Hayashi Y, Ogawa T, Hamawaki J. Smaller facet effusion in association with restabilization at the time of operation in Japanese patients with lumbar degenerative spondylolisthesis. J Neurosurg Spine. 2010;12(1):88–95.

    Article  PubMed  Google Scholar 

  72. Ferreiro Perez A, Garcia Isidro M, Ayerbe E, Castedo J, Jinkins JR. Evaluation of intervertebral disc herniation and hypermobile intersegmental instability in symptomatic adult patients undergoing recumbent and upright MRI of the cervical or lumbosacral spines. Eur J Radiol. 2007;62(3):444–8.

    Article  PubMed  Google Scholar 

  73. Jayakumar P, Nnadi C, Saifuddin A, Macsweeney E, Casey A. Dynamic degenerative lumbar spondylolisthesis: diagnosis with axial loaded magnetic resonance imaging. Spine (Phila Pa 1976). 2006;31(10):E298–301.

    Article  Google Scholar 

  74. Hiwatashi A, Danielson B, Moritani T, et al. Axial loading during MR imaging can influence treatment decision for symptomatic spinal stenosis. AJNR Am J Neuroradiol. 2004;25(2):170–4.

    PubMed  Google Scholar 

  75. Tarantino U, Fanucci E, Iundusi R, et al. Lumbar spine MRI in upright position for diagnosing acute and chronic low back pain: statistical analysis of morphological changes. J Orthop Traumatol. 2013;14(1):15–22.

    Article  PubMed Central  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Northwestern Medical Faculty Foundation, 676 N. Saint Clair, Suite 1350, Chicago, IL, 60611, USA

    Gregory D. Schroeder M.D. & Alpesh A. Patel M.D.

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  1. Gregory D. Schroeder M.D.
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  2. Alpesh A. Patel M.D.
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Correspondence to Alpesh A. Patel M.D. .

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Editors and Affiliations

  1. Assistant Professor of Orthopedic Surgery, Albert Einstein College of Medicine, New York, New York, USA

    Adam L. Wollowick

  2. Associate Professor of Orthopedic Surgery, Albert Einstein College of Medicine, Department of Orthopedic Surgery, Montefiore Medical Center, Bronx, New York, USA

    Vishal Sarwahi

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Schroeder, G.D., Patel, A.A. (2015). Clinical Evaluation of Adult Patient with Spondylolisthesis. In: Wollowick, A., Sarwahi, V. (eds) Spondylolisthesis. Springer, Boston, MA. https://doi.org/10.1007/978-1-4899-7575-1_5

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