Spondylolisthesis is slippage of a 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 when walking or standing for a long time. Treatment is symptomatic and includes physical therapy with lumbar stabilization.
There are five types of spondylolisthesis (1), 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 with the L5 pars being the most common level.
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 for type II spondylolisthesis. For type III (degenerative) there is no defect in the bone.
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Spondylolisthesis is graded according to the percentage of vertebral body length that one vertebra subluxes over the adjacent vertebra (1):
Grade I: 0 to 25%
Grade II: 25 to 50%
Grade III: 50 to 75%
Grade IV: 75 to 100%
Spondylolisthesis is evident on radiographs of the lumbar spine. 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 (2).
References
1. Koslosky E, Gendelberg D. Classification in Brief: The Meyerding Classification System of Spondylolisthesis. Clin Orthop Relat Res2020;478(5):1125-1130. doi:10.1097/CORR.0000000000001153
2. Lin LH, Lin TY, Chang KV, Wu WT, Özçakar L. Effectiveness of Lumbar Segmental Stabilization Exercises in Managing Disability and Pain Intensity Among Patients with Lumbar Spondylolysis and Spondylolisthesis: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Spine (Phila Pa 1976). Published online March 20, 2024. doi:10.1097/BRS.0000000000004989
