Varieties of Spondylolisthesis: (A) Normal, (B) Congenital, (C) Isthmic, (D) Traumatic, (E) Degenerative, and (F) Pathological

DEFINITION
Spondylolisthesis is the defect of pars interarticularis potion of the

vertebrae.
It is defined as slow anterior displacement of a vertebra at the lower
lumbar spine, generally accepted as the lowermost vertebra L5
slipping forward on the first sacral segment S1.
Varieties of spondylolisthesis: (A) Normal, (B) Congenital, (C) Isthmic, (D) Traumatic, (E)
Degenerative, and (F) Pathological
CLASSIFICATION (Wiltse, Macnab and Newman)

Type 1: Congenital spondylolisthesis, characterized by the presence
of dysplastic sacrum facet joints allowing anterior translation of ane
vertebra relative to another
Type 2: Isthmic spondylolisthesis, caused by the development of a
stress fracture of the pars inter articularis
Type 3: Degenerative spondylolisthesis, caused by inter segmental
instability from facet arthropathy
CLINICAL FEATURES
Isthmic Congenital Degenerative
spondylolisthesis spondylolisthesis spondylolisthesis
 Asymptomatic or  Pain—low backache,  Known as
lowback pain. H/o buttocks, feet, toes, pseudospondylolisthe
trauma present in 50 thighs and legs sis
percent
 Common history of  Pain in the back,
injury common in the buttock or thigh
elderly patients in
adults and children
INVESTIGATIONS
 Radiograph of the spine is the investigation of choice.
 Anteroposterior and lateral films are helpful. However, oblique
view of the lumbar spine demonstrates the defect in the pars
very accurately as a “Scottie dog” sign.
 The Scottie dog’s neck, which represents the pars defect, is
broken in the isthmic variety.
 The edges of the defect are smooth and rounded and suggest a
pseudoarthrosis rather than acute fracture.
Radiological Grading
Meyer ding’s grading*
G1 25 percent forward displacement
G2 25-50 percent
G3 50-70 percent
G4 > 75 percent
*Percentage of slip calculated by the upper vertebral displacement
over the lower vertebral body, on a lateral view plain X-ray of the LS
spine.
TREATMENT
Conservative Treatment:
Clinically, spondylolisthesis is divided into three groups,
asymptomatic, mild to moderate and severe varieties, based on the
severity of symptoms.
Different methods of conservative treatment:
Asymptomatic Mild to moderate Severe

 Correction of poor  Alleviation of anxiety  Rest
posture
 Elimination of  Analgesics & muscle  NSAIDs
stressful occupation relaxants
 To avoid certain  Deep heat  Gradual exercises to
special sports strengthen the trunk
activities and hamstring
muscles
 Exercises
Surgical Management:
Indications
 Failure of conservative therapy.

 Signs of root compression.
 Progressive slipping.
 Slip of more than 30 percent even when painless.
 Persistent pain in the back, thigh or persistent sciatica.
Methods of Surgery:
1. Posterolateral fusion: This is the best method of fusing the

slipped vertebra because it preserves the supporting soft tissues
and has a high rate of fusion.
2. Posterior fusion: In this method, postoperative and additional

slip is frequent until the fusion is solid.
This also has a high rate of pseudoarthrosis and has to be done
with intertransverse fusion.
3. Laminectomy: This mainly helps to relieve the neurological

deficits and has to be followed by posterolateral fusion.
Laminectomy and intertransverse fusion.
4. Anterior interbody fusion: This is indicated for subtotal

spondylolisthesis and is a risky and difficult procedure with
doubtful efficacy.
5. Methods of Fusion and Stabilization: Fusion is achieved in

spondylolisthesis by putting autologous cancellous bone graft
and Hartshill rectangle frame or Steffee plate and screws help
obtain stabilization
Physiotherapeutic management
Following conservative management:
Patients are treated with molded collar or by constant bed traction:
 Mobility of the legs and arms is maintained along with
strengthening techniques.
 Emphasis is placed on the shoulder girdle and scapular muscles.
 Gradual mobilization of the cervical spine and progressive
resistive techniques in the available range are given with
emphasis on isometrics for the cervical extensor group of
muscles.
 During immobilization
1. Deep breathing and arm movements encouraged with ankle
and foot movements.
2. Assisted knee movements.
3. Hip flexion, when given, should not be taken beyond 60
degrees.
4. Isometrics to the glutei.
 Mobilization: A POP jacket is applied by the 2nd week of
operation. The jacket continues for a very long time, sometimes
even up to 6 months or till the fusion is evident. Therefore, total
mobilization with the jacket should be instituted immediately.
Educating and guiding the patient to perform functional activities
forms an important part of the management so that he does his
activities of daily life and goes back to work.
When the jacket is removed, gradual mobilization of the spine is
initiated as described in the conservative management section and
progressed till total functional independence is achieved. It may
take 7–8 months to regain full function.

Varieties of Spondylolisthesis: (A) Normal, (B) Congenital, (C) Isthmic, (D) Traumatic, (E) Degenerative, and (F) Pathological

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DEFINITION

Spondylolisthesis is the defect of pars interarticularis potion of the

CLASSIFICATION (Wiltse, Macnab and Newman)

Different methods of conservative treatment:

Asymptomatic Mild to moderate Severe

 Failure of conservative therapy.

1. Posterolateral fusion: This is the best method of fusing the

2. Posterior fusion: In this method, postoperative and additional

3. Laminectomy: This mainly helps to relieve the neurological

4. Anterior interbody fusion: This is indicated for subtotal

5. Methods of Fusion and Stabilization: Fusion is achieved in

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