Spondylolisthesis is forward slipping of one vertebra over the one below, most often at L4-L5 from disc and joint wear in older adults, or at L5-S1 from a pars defect in young athletes. The slip can narrow the canal and press on nerve roots.
Key symptoms
- Low back pain worse with standing and bending backward
- Pain, numbness or tingling down one or both legs
- Tight hamstrings in young patients
- Leg pain with walking that eases with sitting
What you find on exam
- Palpable step-off along the lumbar spinous processes
- Hamstring tightness and lumbar range of motion
- Leg strength, sensation and reflexes
- Gait and posture
Tests
- Standing lateral lumbar X-ray to grade the slip (Meyerding I to V)
- Flexion and extension X-rays to check for instability
- MRI if there are nerve symptoms or before surgery
Treatment basics
- Activity changes and core strengthening physical therapy
- NSAIDs; epidural steroid injection for radiating leg pain
- Brace for young patients with painful slips
- Decompression and fusion for high-grade slips, instability or neurologic deficit
Red flags
- Bladder or bowel changes or saddle numbness
- Progressive leg weakness or foot drop
- Slip that worsens on repeat X-rays in a growing child
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.