Troubles with bladder and bowel function.Problems with walking (gait disturbance).Leg or foot weakness (for example foot drop).Loss of feeling in the legs (numbness or parasthesias).Neurorgenic claudication (pain in backs of calves and legs with walking).The slipping forward of one vertebral body on another, and the uncovering of disc material, can narrow the spaces where the nerves in the lumbar spine are located, causing symptoms such as: In addition to back pain, lumbar spondylolisthesis is associated with symptoms of nerve compression. Back pain can also come from compensatory changes or arthritic changes in the following structures: Back pain can also come from the adjacent intervertebral disc, termed discogenic pain. This pain tends to worse with movements such as bending forward, which leads to exaggeration of the slip. Lower back pain can occur due to spinal instability in spondylolisthesis. When symptomatic, spondylolisthesis can cause back pain and also pain due to compression of the nerves, termed sciatica or radiculopathy. However, in these patients, physiotherapy to strengthen core and spinal muscles, as well as weight loss, are important in order to prevent or delay progression. In patients without symptoms no treatment is generally needed. In these patients monitoring with MRI scans or x-rays is important to determine if the degree of slip is getting worse. In approximately 30% of spondylolisthesis patients, the degree of slip will progress, so it is important to monitor all patients with MRI scans even if they are asymptomatic. Not all patients will be symptomatic from spondylolisthesis and surgery is only indicated for severe symptoms. The severity of spondylolisthesis is graded according to how far one vertebral body slides forward on the other. This is an unfortunate but well recognised complication of laminectomy surgery. Can be seen after laminectomy where the spinal elements at the back of the spine have been removed. Iatrogenic – Due to previous spine surgery which has destabilised the spine.The damage to the bone causes the spine to be unstable leading to the spondylolisthesis. Pathological – Fortunately rare, this type of spondylolisthesis is caused by damage to the bone in the spine due to destructive processes such as infection or cancer.This type is always associated with traumatic injury to the spine. Traumatic – Unstable slipping of one vertebral body due to a fracture in one of the bones of the spine.Most commonly associated with spina bifida or other congenital abnormalities of the spine. Dysplastic – This is a rare congenital condition where there is a defect in the bony arch at the back of the spine.L4/5 is the most common level affected, although other levels can also be affected. Degenerative changes in the intervertebral disc, loss of disc height, ligament laxity and facet joint arthritis lead to instability at the effected level and the slipping forward of one vertebral body. There is usually no bony defect, or pars defect, in this type of spondylolisthesis. Degenerative – This is due to wearing out or degeneration of the spine and is more commonly seen in older people.This commonly occurs in younger people including athletes. Over time the vertebral body above slides forwards on the vertebral body below. These bony defects destabilise the spine. This leads to what is called pars defects in the bony ring (neural arch) at the back of the spine. Isthmic – Isthmic, or lytic, spondylolisthesis, is due to a deformity or fracture (commonly due to fatigue) in a part of bone called the pars interarticularis.Each type has its own cause and treatment options: Routine spinal imaging easily differentiates one type from another. There are different types of spondylolisthesis.
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