Which physical exam 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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See the list below:

  • Isthmic spondylolisthesis

    • 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.

  • Degenerative spondylolisthesis

    • 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.

  • Congenital/dysplastic spondylolisthesis: Physical findings are similar to those described above for isthmic spondylolisthesis.

  • Traumatic and pathologic spondylolisthesis

    • These patients also present with similar findings.

    • A good neurologic evaluation is important.

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