Spondylolisthesis most commonly involves lumbar vertebrae at the level of L4-5 and less commonly, at L3-4. Unilateral or bilateral stress fracture of the pars interarticularis is common. Clinical features include:

• Lower back pain, that worsens after exercise and on coughing and sneezing
• Radiation of pain to the legs along the course of sciatic nerve
• Tingling sensation or numbness in the legs
• Tightness of the hamstring muscles
• Slipping sensation while moving upright
• Muscle spasms
• Reduction in the range of motion of lower back
• Kyphosis
• Abnormal gait (waddling gait)

In severe cases, the patient may develop cauda equina syndrome which is characterized by loss of bladder and bowel tone and their dysfunction.

Diagnosis is made on the basis of the following.

• History
• Myelography with injection of radiopaque dye
• X-ray of lumbar spine
• Computerized tomography imaging
• Magnetic resonance imaging

Conservative treatment is done with the following agents [3] [4]:

• Non-steroidal anti inflammatory drugs (NSAIDs) are given to reduce inflammation and alleviate the pain. Other potent analgesics may also be given.
• Oral steroids (such as prednisone or methylprednisolone) can be given in severe cases. Epidural steroid injections may also be given.
• Physiotherapy, lumbar traction, thermal treatment, electrical stimulation and lumbosacral orthoses are other treatment options for the management of spondylolisthesis.
• Braces are recommended for spinal support.
• Chiropractic therapy can also help in reducing the severity of symptoms.

Surgical treatment includes:

• Spinal fusion. The three most common methods are postero-lateral (intertransverse) fusion, lumbar interbody fusion and pars repair [5] [6]. Antiplatelet and anti-inflammatory therapies are the contraindications of fusion.
• In situ anterior fusion (ALIF), for high grade spondylolisthesis [7]
• Fixation
• Decompression [8] [9]
• Reduction [10]

Rehabilitation therapy should also be included in the treatment.

The prognosis of the disease is usually good, with a large majority of patients responding to conservative therapeutic measures. Rarely, involvement of nerve roots can lead to concomitant morbidities like cauda equina syndrome.

Surgical treatment may take up to 3 months to heal but the patients usually recover with excellent prognosis [1] [2]. Degenerative spondylolisthesis is associated with worsening of symptoms with time and poor prognosis.

Based on etiology, spondylolisthesis is divided into five major categories:

• Isthmic spondylolisthesis: This is the most common form of spondylolisthesis. A defect in pars interarticularis leads to this form. Hyperextended posture is the common cause.
• Dysplastic spondylolisthesis: This develops due to defect in the development of vertebral facets. It is a congenital disorder.
• Pathologic spondylolisthesis: This develops as a result of bone disorders. 
• Traumatic spondylolisthesis: This results due to direct trauma to the spine. Fractures of pedicle, lamina or facet joints are commonly associated with this form.
• Degenerative spondylolisthesis: Arthritic changes in the joints contribute to the development of this form of spondylolisthesis. It is the common in old age.

A prevalence rate of 5-7% has been found in the United States population. Spondylolisthesis is common in athletes and gymnasts as a result of hyperextended postures. Patients with family history of bone defects are more prone to develop spondylolisthesis. It is also common in old age.

Pars interarticularis or isthmus is present in the posterior part of the vertebra. It may be congenitally absent (dysplastic), or may sustain damage as a result of repeated strain (isthmic) or direct trauma (traumatic). The posterior support of vertebrae is lost (intersegmental instability) and the vertebra slips on the underlying vertebra. Defective bone mineralization (pathologic) and degenerative changes can also lead to spondylolisthesis. The spinal canal may undergo narrowing and stenosis. Nerve roots may also be crushed leading to pain along the course of the involved nerve.

Meyerding’s classification system divides spondylolisthesis into 4 grades depending upon the degree of slippage of the involved vertebra:

• Grade 1: Less than or equal to 25% anterior displacement as compared to the underlying vertebra.
• Grade 2: 26% to 50% anterior displacement.
• Grade 3: 51% to 75% anterior displacement.
• Grade 4: More than 75% anterior displacement.

• Avoiding undue pressure on the vertebrae while exercising can help prevent spondylolisthesis.
• Mild exercises that strengthen the back muscles should be done according to the advice of physiotherapist.
• Smoking has been found to contribute to failure of fusion procedure so, it should be avoided. Similarly, alcohol should be avoided.
• Complete rest should be observed by such patients.
• Posture should be maintained to avoid stress on the spinal column. Back should be kept straight and the shoulders, square, without hunching over.
• Healthy, low-fat and low-sodium diet should be consumed.
• In obese people, weight loss can help reduce the severity of symptoms by decreasing the strain on the spinal column.
• Lifting heavy weights should be avoided during post-operative period to prevent recurrence.

Spondylolisthesis is the condition in which a vertebra slips forward in position relative to the adjacent vertebra. The forward sipping is also known as anterolisthesis, whereas, the backward displacement of a disc is known as retrolisthesis. A number of causes contribute to the development of this disease.

The patient may remain asymptomatic or have varying degrees of symptoms depending upon the degree of slippage. Spinal deformities and nerve abnormalities constitute the complications of spondylolisthesis.

Spondylolisthesis is the disease in which one of the vertebrae of the spinal column slips forward on the one lying beneath it. The causes of the disease may include trauma, bone erosion or degenerative changes occurring in the bones with age.

The common presentations of this disorder are pain in the lower back region that might spread to the buttocks and the back of legs. Muscle cramps are common. The person may develop abnormal posture and gait due to severity of the symptoms.

The patient is treated with anti-inflammatory drugs. Physiotherapy is the first line of treatment. Complicated cases are surgically treated. The patient usually recovers and the risk of morbidity is low.

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