Spondylolisthesis

Introduction

The skeletal anatomy involved in spondylolisthesis is complex but, in brief, it works like this: Each vertebra in the spine has a thick anterior body (called the centrum). A vertebral (or neural) arch on the surface of the centrum encloses a "vertebral foramen," which the spinal cord passes through. On each side of the neural arch on each vertebra, a pair of "superior articulating processes" projects up, and pair of "inferior articulating processes" projects down, supplying support and flexibility.

Spondylolysis is the degeneration or deficient development of these articulating parts of the vertebra. It can range from a serious condition to a mild one.

Spondylolysis may permit forward slippage of a vertebra onto the next vertebra below it, producing a spondylolisthesis. Spondylolysis occurs in 6% of the population, but only in people who can stand upright and walk. Spondylolysis is more common among athletes active in sports that require repetitive hyperextension, such as diving, weight lifting, wrestling and gymnastics.

Children and teens with this condition may have no symptoms, though symptoms often develop during the preadolescent growth spurt. The magnitude of symptoms does not always correlate with the severity of the slipped vertebra. Many people with this condition don't require treatment. Spondylolysis or low-grade spondylolisthesis may be managed conservatively without surgery. However, young ("skeletally immature") people with more than 30 to 50% slippage are at increased risk for progression and are candidates for spinal fusion without delay. For other patients, treatment can vary from surgery to physical therapy to modification of activities.

Spondylolisthesis has an emotional impact because pain can limit function and impair quality of life. Education is important in giving the patient a sense of control and the information necessary to make informed treatment decisions.

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