What is it?

Degenerative spondylolisthesis is a condition that often occurs in adulthood (50 years and over) and affects mainly the lumbar spine (L4 hysteresis). It is characterized by slippage of the vertebra in relation to the underlying vertebra. It can be associated with intervertebral disc degeneration (discopathy), articular facet arthrosis, and spinal canal stenosis.   Vertebral slippage (Grade I < 25%, Grade II 25-50% and Grade III > 50% according to Meyerding) and the resulting mechanical instability may be associated with chronic low back pain and radicular abnormalities in the lower extremities of varying degrees and difficulty walking long distances (neurogenic claudication).

Which are the symptoms?

Initially, the lower back pain is mild and disappears after rest. It gradually becomes chronic and worsens with prolonged standing and walking. This may be due to radiation to the lower limbs or to decreased independent walking (neurogenic claudication). Symptoms may progressively worsen and become more persistent.

The symptoms depend on one hand on the mechanical change of the slipped spinal segment, resulting in functional overload of the disc, which undergoes progressive degeneration, and on the other hand on compression of the nerve structures secondary to the progressive reduction in the diameter of the conjugation hole and the spinal canal.

  • acute low back pain
  • chronic low back pain
  • radiculitis
  • radiculopathy
  • neurogenic claudication
  • decreased walking autonomy

How is it diagnosed?

A thorough physical and neurological examination is necessary to detect the presence of neurological abnormalities or deficits. Radiological examinations that need to be done by the patient in order to make a diagnosis include:
Standard radiographic studies (Rx lumbosacral spine 2P in orthostasis, if necessary Rx lumbosacral spine in dynamic projections of maximal flexion and maximal extension. Full spinal telerexis in orthostasis)
MRI: useful for assessment of herniated discs, canal stenosis, degree of discopathy, radicular compression/conflict.
CT: excellent for detection of posterior disc or posterior longitudinal ligament calcifications.
Instrumental examinations must show the presence of disease correlating with the clinical picture.

Suggested exams

How is it treated?

The non-surgical treatment pathway

It consists of anti-inflammatory drug therapy, analgesic therapy, corticosteroid therapy, infiltration therapy when indicated, physiotherapy when indicated and modification of physical activity that can cause strain on the spinal axis when indicated. 

Patients with spondylolisthesis are indicated for surgical treatment in the presence of disabling pain symptoms, resistant to medical and physical therapy, present for at least 3 months, and especially when pain irradiates to the lower limbs with or without the presence of neurological claudication or neurological deficits.

Evaluating the clinical picture and reviewing the radiological picture is very important in determining the severity of the pathology and, therefore, in choosing the surgical program.

The primary goal of surgery is to stabilize the affected area of the spine in order to prevent the progression of the pathology and reduce pain syndrome. Decompression of the affected neurological structures is also necessary in the presence of neurological pain symptoms or neurological deficits.

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