Lumbosacral Spondylolisthesis(Archived)

Excerpt

Lumbosacral spondylolisthesis is the forward translation of the fifth lumbar vertebra (L5) over the first sacral vertebra (S1). Bilateral L5 pars defect (spondylolysis) or repetitive stress injury is the primary etiology behind lumbosacral spondylolisthesis. The degree of a slip often correlates with the degree of symptoms.

The prevalence of spondylolysis (pars defect) in the general population is 6%, and a third of those subsequently develop a degree of spondylolisthesis. The majority of cases are mild or asymptomatic, and only a relatively small percentage of symptomatic patients require surgical intervention.

The most commonly affected populations are children and adolescents participating in sports that require repetitive lower back hyperextension (divers, pace cricket bowlers, baseball, softball, rugby, weightlifting, sailing, table tennis, wrestlers, gymnasts, dancers, and footballers). They typically present with lower back pain that is exacerbated by activity. Occasionally, pain can radiate to both buttocks and legs, and in advanced cases, the gait pattern and walking distance may be affected. Presentation in adults is more insidious and commonly associated with long-standing degenerative changes secondary to the slip, often leading to spinal canal stenosis and radicular pain. Management of the majority of the cases is non-operative, but patients who fail non-operative treatment and continue having disabling symptoms may require surgical treatment.