![]() ![]() Physical therapy : e.g., bracing, back-strengthening exercises.Consider as initial treatment for high-grade degenerative spondylolisthesis with no significant neurological involvement.Initial treatment for patients with low-grade slippage and no significant neurological involvement.Immediate surgery consultation is required for patients with motor deficit or cauda equina syndrome to evaluate the need for emergency surgical decompression. Surgical treatment is usually reserved for patients with high-grade slippage or persistent symptoms.Conservative treatment can be attempted initially in most patients.Treatment goals are to reduce pain, restore mobility, and prevent disease progression.High-grade spondylolisthesis of L5 over S1 due to bilateral spondylolysis (inverted Napoleon hat sign).Degenerative changes, e.g., disk space narrowing, vacuum phenomenon, endplate sclerosis.L5 over S1: most common in isthmic spondylolisthesis.L4 over L5: most common in degenerative spondylolisthesis.Supportive findings: anterior vertebral displacement ( anterolisthesis).Dynamic flexion-extension ( lateral view): Consider performing to assess for spinal instability.Indications: initial test for all patients in whom spondylolisthesis is suspected.Spondylolisthesis is often an incidental finding. Imaging studies confirm the diagnosis, help monitor progression, and are needed to guide the treatment.Consider in patients with characteristic clinical features in asymptomatic patients, the diagnosis may be incidental.Straight leg raise test : A positive test indicates lumbar radiculopathy.Weakness and atrophy in lower legs reduced sensation and reflexes.Positive sign: visible or palpable step-off sign at the lumbosacral area.Procedure: Observe and palpate the spinous processes to identify any slippage of the vertebrae.Step-off sign (seen in advanced stages).Reduced lumbar range of motion and reduced lumbar lordosis.Possible physical examination findings.Other features of neurological involvement include :.Gait problems (e.g., waddling gait, neurogenic claudication ).Often associated with numbness, paresthesias, and muscle weakness.Radiates to the gluteal and posterior thigh regions.Acute or chronic lumbar pain that worsens with activity and/or with spine extension.The severity of symptoms often correlates with the degree of vertebral slippage. Overall, children and adolescents have better outcomes than adults and elderly patients. Surgical treatment (e.g., vertebral fusion, decompression laminectomy) is reserved for patients with refractory symptoms and/or neurological deficits. Most patients achieve good symptomatic control with conservative treatment (e.g., physical therapy). Some patients have a palpable step-off sign at the lumbosacral area. Spondylolisthesis may be asymptomatic or cause lumbar pain on exertion, gait problems, radiculopathic pain, or urinary incontinence. Other forms of spondylolisthesis may be associated with congenital disease, trauma or bone fractures, and underlying bone pathology (e.g., Paget disease). Degenerative spondylolisthesis occurs at L4–L5 and most commonly affects individuals over 50 years of age. This form is most prevalent in children and adolescents and is often associated with repetitive hyperextension of the spine (e.g., in gymnasts). Isthmic spondylolisthesis is associated with a disruption of the vertebral ring and most commonly occurs at L5– S1. The two most common forms of spondylolisthesis are isthmic and degenerative. The condition affects up to 10% of the population. ![]() Spondylolisthesis is a condition in which a vertebral body slips anteriorly in relation to the subjacent vertebrae. ![]()
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