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Spondylolisthesis Overview

Jul 4, 2025

Overview

This lecture covers spondylolisthesis ("spondy"), its clinical presentation, diagnosis, and management options, including both conservative and surgical treatments.

Definition and Clinical Features

  • Spondylolisthesis refers to one vertebral body slipping forward over another.
  • Patients often have combined back pain and nerve root (leg) pain.
  • Slip causes tightness and tension on lumbar joints, leading to back pain.
  • Symptoms and exam findings can mimic a herniated disc: motor weakness, variable paresthesias, and pain.

Diagnosis

  • MRI or myelogram is needed to assess nerve involvement.
  • Dynamic (flexion-extension) x-rays help determine if the slip is mobile or fixed.
  • If movement is seen on dynamic x-ray, spinal fusion may be needed.

Terminology

  • Spondylolisthesis = "spondy" = vertebral slip.
  • Pars defect: anatomical defect promoting the slip and spinal canal narrowing (stenosis).

Management

  • Conservative treatment includes physical therapy, injections, and sometimes chronic opioids.
  • Patients should expect some lifelong back pain; total elimination is unlikely.
  • Surgery is considered if conservative measures fail or if the slip is mobile.
  • Surgical decompression relieves nerve/leg pain; fusion stabilizes the spine and addresses back pain.
  • Fusion carries risks: higher blood loss, longer recovery, increased risk of adjacent segment degeneration.
  • Fusion is avoided in very elderly and young patients due to risks of further degeneration or stress.

Key Terms & Definitions

  • Spondylolisthesis — Forward slip of one vertebra over another.
  • Pars defect — Structural defect in the vertebral arch facilitating vertebral slip.
  • Dynamic x-ray — Imaging technique assessing spine movement with flexion and extension positions.
  • Decompression — Surgical removal of bone/tissue to relieve nerve pressure.
  • Fusion — Surgical joining of vertebrae to stabilize the spine.

Action Items / Next Steps

  • Review anatomy of the pars interarticularis.
  • Understand indications for conservative versus surgical management of spondylolisthesis.

Full transcript