Lumbar Spondylolisthesis — Presentation and Management
DNB Orthopaedics • May 2024 • Paper II • 10 Marks
Introduction
Spondylolisthesis is the displacement of one vertebral body relative to the vertebra below it, usually anteriorly. In the lumbar spine, the common clinically important patterns are isthmic spondylolisthesis, usually at L5–S1, and degenerative spondylolisthesis, commonly at L4–L5.
Core principle: Treatment is determined by symptoms, neurological compromise, instability, slip progression and spinopelvic alignment — not merely by the percentage of slip.
Definitions
Spondylolysis
Defect or stress fracture through the pars interarticularis, commonly at L5.
Spondylolisthesis
Translation of one vertebra relative to the vertebra below.
Wiltse–Newman Classification
| Type | Cause | Typical Feature |
|---|---|---|
| I — Dysplastic | Congenital abnormality of lumbosacral junction | Often high-grade slip, young patient |
| II — Isthmic | Pars interarticularis lesion | Commonly L5–S1 |
| III — Degenerative | Facet/disc degeneration without pars defect | Commonly L4–L5 |
| IV — Traumatic | Acute fracture outside pars | Instability after trauma |
| V — Pathological | Bone disease weakening posterior elements | Tumor, metabolic disease etc. |
| VI — Iatrogenic | Postoperative destabilization | After excessive decompression/facetectomy |
Isthmic Spondylolisthesis — Type II Subtypes
- IIA — Lytic: fatigue fracture of pars
- IIB — Elongated pars: healed stress injury with elongated pars
- IIC — Acute pars fracture: relatively…