We treat more than 600 patients with spondylolisthesis each year.
Symptoms associated with spondylolisthesis often include:
test uses X-rays to view the bony vertebrae in your spine and can tell your doctor if any of them are too close together or whether you have arthritic changes, bone spurs, fractures, or any slippage of the vertebrae (Fig. 4).
The amount of pain you have depends on how fast your vertebrae are slipping. If you have very subtle symptoms, you may only feel tightness in your hamstrings or find that you can no longer touch your toes, but not feel any nerve pain.
Spondylolisthesis - Slipped Vertebrae - YouTube
An ache in the low back and buttock areas is the most common complaint in patients with spondylolisthesis. Pain is usually worse when bending backward and may be eased by bending the spine forward.
Slipped vertebrae are the result of spondylolisthesis
The most common grading system for spondylolisthesis is the Meyerding grading system for severity of slip. The system categorizes severity based upon measurements on lateral X-ray of the distance from the posterior edge of the superior vertebral body to the posterior edge of the adjacent inferior vertebral body. This distance is then reported as a percentage of the total superior vertebral body length:
Spondylolisthesis | Slipped Vertebrae Injuries
Additionally, the cause of pain in patients with isthmic spondylolisthesis remains unclear. The first theory of pain production was segmental instability with excessive forward translation during flexion. This notion was logical from the mechanical standpoint as the pars defect eliminated the vertebral body’s primary restraint to forward translation, the inferior facet joint. This theory has now been evaluated by multiple radiographic studies, none of which were able to demonstrate excessive forward translation as a common feature of isthmic spondylolisthesis. A more contemporary theory of pain generation is excessive tension on the annulus of the inferior disc and foraminal stenosis at the level of the slip. Excessive annular tension is also mechanically logical as without the restraint of the inferior facet joints; the disc has to both resist shear forces from the slip and compressive forces from the body’s mass. However, this theory does not explain why some patients have symptoms while so many others do not, since the inferior discs all patients with isthmic spondylolisthesis are subjected to similar forces. Foraminal stenosis is also thought to play a role, but long-term studies on surgical outcome have shown that many patients have poor results following decompression alone. Since the mid-1950s, surgeons have been advocating the combination of decompression and fusion. A recent biomechanical study of flexion-extension X-rays in patients with isthmic spondylolisthesis and normal controls found paradoxical motion at the level of the slip in 46% of patients and 0% of controls without back pain. Paradoxical motion has not been previously reported in cases of spondylolisthesis, but its role in the symptomatic and asymptomatic patient is unclear.