What are the signs and symptoms of lumbar spondylolysis and spondylolisthesis?

Updated: Jul 08, 2020
  • Author: Beth B Froese, MD; Chief Editor: Stephen Kishner, MD, MHA  more...
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Answer

Signs and symptoms of isthmic spondylolisthesis include the following

  • Hamstring tightness is observed almost universally, even in low-grade spondylolisthesis
  • Lumbar spasm may be present
  • A palpable step-off is noted with slips equal to or greater than grade 2
  • With higher degrees of spondylolisthesis, an increased lumbosacral kyphosis is seen (50% or greater), along with a compensatory thoracolumbar lordosis; truncal shortening may be present; with severe slips, the rib cage may rest on the iliac crest
  • Dermatomal weakness may be present if a radiculopathy or an element of stenosis is present
  • A waddling gait may be noted secondary to hamstring tightness producing a shortened stride length
  • If spondylolisthesis is not present, spondylolysis presents with paraspinal spasm, pain provocation with lumbar spine extension, and tight hamstrings

Signs and symptoms of degenerative spondylolisthesis include the following:

  • These patients present with less prominent physical findings; pain often is provoked with lumbar spine extension
  • If lumbar stenosis is present, then reflexes may be diminished; radicular findings also may be present

In congenital/dysplastic spondylolisthesis, physical findings are similar to those described above for isthmic spondylolisthesis.

Patients with traumatic and pathologic spondylolisthesis also present with similar findings. A good neurologic evaluation is important.


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