Coupon Accepted Successfully!


Spondylolisthesis & Spondylolysis

The term "Spondylolisthesis" refers to a condition where one of the vertebrae (usually L5) becomes misaligned anteriorly (slips forward) in relation to the vertebra below. This forward slippage – is caused by a problem or defect within the pars interarticularis.

This non-slipped pars defect is called a "Spondylolysis" and is almost always a precursor to the actual forward slippage.

  1. It nearly always occur between L5 & S1. (most common) or L4 and L5. Spondylolysis is characterized by presence of bony defect at pars intearticularis, which can result in spondylolisthesis.
  2. High incidence of spondylolysis in gymnasts, football player, weight lifters & other athletes who place their lumbar spine in hyperextension suggest repetitive injury may be contributing mechanism.
  3. In adolescents & adults intermittent backache or Sciatica may occur in one or both leg.
  4. The extent of slippage may not be correlated with severity of pain. In young patient regardless of extent of slip there may be tight hamstrings and a knee bent, hips-flexed gait, the classical Phalen Dickson sign
  5. On examination buttocks look flat, the sacrum appears to extend to the waist and transverse loin creases are seen
  6. ‘Step off can be felt when the fingers are run down the spine, secondary to prominent spinous process of L5. With more severe slippage the lumbosacral junction becomes more kyphotic and the trunk appears shortened with the rib cage approching the iliac crest.
  7. Percentage of slippage is measured on lateral view and oblique rdiograph demonstrate collar (Spondylolysis) or broken neck on the scottie dog (Spondylolisthesis).

  1. Elongated neck –lysis
  2. Beheaded –listhesis
  3. Inverted napolean hat sign

X-rays in spondylolisthesis

  • In early stages of spondylolisthesis CT Scan can detect even mild slip
  • MRI can tell the extent of neural compression
  • And with progression lateral view of spine can show the spondylolisthesis
  • AP View of spine can tell about spondylolisthesis once complete vertebra topples over the lower one and inverted napoleon hat sign is seen
  • Thus AP view is of least importance in spondylolisthesis.



Physiotherapy, pain control and corset


Indications of surgery in diseases of spine

  1. Failure of conservative management
  2. Deterioration on conservative management

Operative procedure includes decompression, stabilization ( instrumentation) and fusion.

Cervical spondylosis

It is cluster of abnormalities arising from chronic intervertebral disc degeneration. Like disc prolapse it usually occurs immediately above or below the 6th cervical vertebral (in lower two segments C5-7)

  1. Pathophysiology
    Degeneration of disc (loss of water & proteoglycan) causes decrease of disc height (k/a hard disc) & causing converging of disc space causing
    1. 1Segmental instability resulting in facet joint arthropathyQ and hypertrophic osteophyte formation by uncovertebral joint of Luschka & by facet joints. These spurs result in compression of existing nerve root (in intervertebral foramen)Q and later the spinal cord (in spinal canal).
    2. Buckling of ligamentum flavum & narrowing of spinal canal.
    3. Ligamentous instability
    4. Radiculopathy (more common), myelopathy or both may be seen secondarily
  2. Clinical Feature
    1. Headache, neck pain & stiffness, worse in morning & improving throughout day, commonly located in occipital region and radiating to frontal area, back of shoulders & down one or both arms.
    2. With radiculopathy (lower motor neuron) sensory involvement in form of paraesthesia or hyperesthesia is more common than motor or reflex changes. Typically patients have proximal arm pains & distal paresthesia
    3. Muscles of back of neck & interscapular region may be tender and neck movements limited.
    4. X rays reveal spur / osteophyte formation (or lipping) at the anterior & posterior margins of disc.

Test Your Skills Now!
Take a Quiz now
Reviewer Name