Merck Manual

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Peter J. Moley

, MD, Hospital for Special Surgery

Last full review/revision Nov 2020| Content last modified Nov 2020
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Spondylolisthesis is slippage of a lumbar vertebra in relation to the vertebra below it. Anterior slippage (anterolisthesis) is more common than posterior slippage (retrolisthesis). Spondylolisthesis has multiple causes. It can occur anywhere in the spine and is most common in the lumbar and cervical regions. Lumbar spondylolisthesis may be asymptomatic or cause pain on walking or standing for a long time. Treatment is symptomatic and includes physical therapy with lumbar stabilization.

There are five types of spondylolisthesis, categorized based on the etiology:

  • Type I, congenital: caused by agenesis of superior articular facet

  • Type II, isthmic: caused by a defect in the pars interarticularis (spondylolysis)

  • Type III, degenerative: caused by articular degeneration as occurs in conjunction with osteoarthritis

  • Type IV, traumatic: caused by fracture, dislocation, or other injury

  • Type V, pathologic: caused by infection, cancer, or other bony abnormalities

Spondylolisthesis usually involves the L3-L4, L4-L5, or most commonly the L5-S1 vertebrae.

Types II (isthmic) and III (degenerative) are the most common.

Type II often occurs in adolescents or young adults who are athletes and who have had only minimal trauma; the cause is a weakening of lumbar posterior elements by a defect in the pars interarticularis (spondylolysis). In most younger patients, the defect results from an overuse injury or stress fracture.

Type III (degenerative) can occur in patients who are > 60 and have osteoarthritis; this form is six times more common in women than men.

Anterolisthesis requires bilateral defects.

Spondylolisthesis is graded according to the percentage of vertebral body length that one vertebra subluxes over the adjacent vertebra:

  • Grade I: 0 to 25%

  • Grade II: 25 to 50%

  • Grade III: 50 to 75%

  • Grade IV: 75 to 100%

Spondylolisthesis is evident on plain lumbar x-rays. The lateral view is usually used for grading. Flexion and extension views may be done to check for increased angulation or forward movement.

Mild to moderate spondylolisthesis (anterolisthesis of 50%), particularly in the young, may cause little or no pain. Spondylolisthesis can predispose to later development of foraminal stenosis. Spondylolisthesis is generally stable over time (ie, permanent and limited in degree).

Treatment of spondylolisthesis is usually symptomatic. Physical therapy with lumbar stabilization exercises may be helpful.

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