What causes 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

A genetic predisposition to isthmic spondylolisthesis is believed to be linked with patients having a thin pars or subtle hypoplastic facet joints. Family members have a reported incidence of 28-69%. Activities requiring lumbar extension stress increase the risk. Patients with spina bifida occulta are known to have a higher occurrence. [15]

Degenerative spondylolisthesis is caused by facet degeneration accompanied by disk degeneration most commonly at the level of L4-L5. Some studies identify sagittally oriented facets as more prone to arthritic change.

Congenital spondylolisthesis is due to dysplastic sacral or lower lumbar segments. Dysplastic facets or abnormal orientation of the facet joints are the cause for spondylolisthesis.

Traumatic spondylolisthesis is rare. In theory, severe hyperextension stress placed on the pars could produce fracture and instability. One should keep in mind that hyperflexion-distraction forces can cause facet dislocation and spondylolisthesis.

Pathologic spondylolisthesis can occur as a result of any bone lesion that might weaken the posterior elements. Generalized skeletal diseases including osteomalacia, syphilitic disease, and Von Recklinghausen disease are some reported causes. Bony destructive lesions, including tumor or infection, are other potential causes.

A study by Sakai et al suggested that male patients with L5 spondylolysis may be congenitally predisposed to the condition. The report involved 36 patients (37 vertebrae) with terminal-stage spondylolysis that was not diagnosed until adulthood, with 33 of the vertebrae (89.2%) having L5 spondylolysis, 14 of the patients (38.9%) having neither a history of athletic activity nor the occurrence of low back pain during their growth period, and nine patients (25%), eight of whom were men, having spina bifida occulta concurrently with L5 spondylolysis. [16]


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