Which clinical history findings are characteristic 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

See the list below:

  • Isthmic spondylolisthesis

    • Symptoms often occur around the time of an adolescent growth spurt.

    • Some report acute onset of focal low back pain during activity, while others have more insidious onset.

    • Radiating pain may extend to the buttocks or thigh. Pain may be more significant and have mechanical characteristics with higher grades of spondylolisthesis.

    • In most cases, patients do not complain of symptoms suggesting neurologic deficit with lower grades of spondylolisthesis. Radicular pain becomes more common with larger slips. Complaints of radiating pain below the level of the knee associated with numbness and tingling in a dermatomal distribution would suggest the presence a radiculopathy resulting from either the foraminal stenosis that occurs with spondylolisthesis or a concomitant herniated disk. Nerve root impingement from the fibrocartilaginous bar that forms at the sight of the lysis may occur. High degrees of spondylolisthesis may present with neurogenic claudication or symptoms suggesting cauda equina impingement.

    • The patient's pain usually is provoked by activity, particularly back extension activities.

    • Patients with acute spondylolysis tend to demonstrate poor tolerance of activities requiring excessive spine loading, including running and jumping. Sitting usually is better tolerated.

    • A large percentage of patients with spondylolysis are asymptomatic. Progression of a spondylolisthesis also may occur without symptoms.

  • Degenerative spondylolisthesis

    • The pain begins insidiously and may be achy in character. Pain is located in the low back and posterior thighs.

    • Neurogenic claudication may be present as well, with lower extremity symptoms being made worse with activity and better with rest.

    • Symptoms are often chronic and progressive, although patients may experience periods of remission.

  • Dysplastic spondylolisthesis: Symptoms present much like isthmic spondylolisthesis, but neurologic compromise is more likely.

  • Traumatic spondylolisthesis

    • Patients present with acute pain associated with trauma.

    • If a slip is severe enough, cauda equina compression may occur and present with classic symptoms including bowel and bladder dysfunction, radicular symptoms, or neurogenic claudication.

  • Pathologic spondylolisthesis: Symptoms may be insidious in onset and associated with radicular pain/claudication.


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