spondylolisthesis (listhesis, olisthesis)
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Introduction
Subluxation of the body of a vertebra on the vertebra below. (at least 3 mm at the lumbar spine)
Etiology
Epidemiology
- prevalence of lumbar spondylolisthesis 8.7%
Pathology
- sacrum may become more vertical, impairing hip extension
- neurologic involvement is uncommon because vertebra slips anteriorly, away from spinal cord & nerve roots
Clinical manifestations
- prominent spinal process may be palpable
- impaired gait, flexed knee, flexed hip (Phalen-Dickson sign)
- leg pain upon prolonged standing or walking[9]
- exercise in sitting position (cycling) generally tolerated
- neurologic involvement is uncommon
Radiology
- standing flexion-extension radiographs of lumbar spine
- subluxation a vertebral body on the vertebra below
- images
- radiograph of C2[8]
- computed tomography through C2 (image)[8]
Complications
Differential diagnosis
Management
- treatment is controversial
- chiropractic manipulation is considered to be helpful
- physical therapy
- lumbar bracing to prevent hyperextension
- rest
- non-steroidal anti-inflammatory agents
- referral to orthopedic surgeon[4]
- indications for surgical fusion
- intractable pain
- growing child with slippage > 50%
- addition of fusion to decompression in patients with lumbar spinal stenosis & spondylolisthesis may have small benefit[7]
- decompression + fusion no better than decompression alone[11]
- epidural glucocorticoids dont seem to effect surgical or non-surgical management of degenerative lumbar spondylolisthesis[10]
More general terms
More specific terms
Additional terms
- back pain
- spondylitis
- spondyloarthropathy (HLA B27-associated arthritis, seronegative spondyloarthropathy)
- spondylolysis
- spondylosis
References
- ↑ Vogt MT, Rubin DA, Palermo L, Christianson L, Kang JD, Nevitt MC, Cauley JA. Lumbar spine listhesis in older African American women. Spine J. 2003 Jul-Aug;3(4):255-61. PMID: https://www.ncbi.nlm.nih.gov/pubmed/14589183
- ↑ Iguchi T, Wakami T, Kurihara A, Kasahara K, Yoshiya S, Nishida K. Lumbar multilevel degenerative spondylolisthesis: radiological evaluation and factors related to anterolisthesis and retrolisthesis. J Spinal Disord Tech. 2002 Apr;15(2):93-9. PMID: https://www.ncbi.nlm.nih.gov/pubmed/11927816
- ↑ Pellengahr C, Pfahler M, Kuhr M, Hohmann D. Influence of facet joint angles and asymmetric disk collapse on degenerative olisthesis of the cervical spine. Orthopedics. 2000 Jul;23(7):697-701. PMID: https://www.ncbi.nlm.nih.gov/pubmed/10917245
- ↑ 4.0 4.1 UpToDate 14.1 http://www.utdol.com
- ↑ Weinstein JN et al, Surgical versus nonsurgical treatment for lumbar degenerative spondylolisthesis N Engl J Med 2007, 356:2257
- ↑ Diagnosis and treatment of degenerative lumbar spondylolisthesis. North American Spine Society <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/10917245 <Internet> http://www.spine.org/Documents/Spondylolisthesis_Clinical_Guideline.pdf
- ↑ 7.0 7.1 Ghogawala Z, Dziura J, Butler WE et al Laminectomy plus Fusion versus Laminectomy Alone for Lumbar Spondylolisthesis. N Engl J Med 2016; 374:1424-1434. April 14, 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27074067 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1508788
- ↑ 8.0 8.1 8.2 Khelifi A, Saadaoui F. (case presentation) Traumatic Spondylolisthesis of the Axis. N Engl J Med 2017; 376:1782May 4, 2017 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28467872 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMicm1405867
- ↑ 9.0 9.1 Geriatric Review Syllabus, 10th edition (GRS10) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2019
- ↑ Gerling MC et al. Epidural steroid injections for management of degenerative spondylolisthesis: Little effect on clinical outcomes in operatively and nonoperatively treated patients. J Bone Joint Surg Am 2020 Aug 5; 102:1297 PMID: https://www.ncbi.nlm.nih.gov/pubmed/32769595
- ↑ 11.0 11.1 Austevoll IM et al. Decompression with or without fusion in degenerative lumbar spondylolisthesis. N Engl J Med 2021 Aug 5; 385:526. PMID: https://www.ncbi.nlm.nih.gov/pubmed/34347953
Lau KKL et al. Demographic, surgical, and radiographic risk factors for symptomatic adjacent segment disease after lumbar fusion: A systematic review and meta-analysis. J Bone Joint Surg Am 2021 Aug 4; 103:1438. PMID: https://www.ncbi.nlm.nih.gov/pubmed/34166276