Spondylolisthesis is the anterior displacement of one vertebra over another and is usually caused by the failure of anatomical structures like facets or the posterior bony arch. It is most commonly seen at L4-L5 and L5-S1 levels. Symptoms include axial pain, neurogenic claudication, and radiculopathy. Treatment depends on the degree of slip and presence of neurological symptoms, ranging from conservative management to surgical procedures like fusion either with or without instrumentation.

1. Dr (Major) Parthasarathy S
Pg Resident,MS Orthopaedics
Stanley Medical College,Chennai
Ref:Campbell’s operative orhopaedics 13th
edition

2.  Greek word
 Spondylo(spine)
 olisthesis(slip)
 First described by Herbinaux(Obstetrician) in
1782
 Ant translation of cephalad vertebra relative
to adjacent caudal vertebra

3.  Anteriorely directed vector created by
contraction of erector spinae muscle &force
of gravity acting on upper body mass
 Not seen in children before ambulation
 Failure of anatomic structures
 Facets
 Posterior bony arch
 pedicles

5.  Axial pain
 Neurogenic claudication
 Radiculopathy
 Cauda equina syndrome
 Sagittal imbalance
 Truncal shortening

6. Type VI,iatrogenic
Most common type
L4-5
L5-S1 level common

11. >25% threshold of
signicant sacral
deformity

12. SS+PT=PI

13. Slip angle >30 & lumbosacral angle >10 have
predictive value for progression

14.  LS spine X-ray
 AP
 Lat
 Lat flexion/extension
 Oblique if suspecting spondylolysis
 MRI
 SPECT
 HRCT

18.  Absence of significant neurological deficit
 Translation <1-2mm
 Control acute sympoms then trunk
stabilisation exercise & physiotherapy
 Epidural steroid
 Back pain not controlled in 6 months-surgery

19.  Repair of pars interartcularis defect
 No spondylolisthesis
 No degenerative disc changes in that level
 No degenerative facet changes
 No dysplastic changes
 Method – pedicle screw fixation & bone
grafting

20.  Instrumented posterolateral fusion(wiltse &
spencer)
 No significant neurological symptom
 Good spinal alignment
 Sufficient surface area >2cm2 of transverse process
 Less surface area for posterolateral fusion
 Posterior only approach with circumferential
fusion(posteior/transforaminal lumbar interbody
fusion PLIF/TLIF)
 Ant lumbar interbody fusion with post supplemental
fixation
 Used if small transverse process
 Salvage procedure if non union in posterolateral
fusion
 Patients with neurological symptom
 Direct/indirect decompression also needed

25.  Lumbar decompression & posterolateral
fusion with or without instrumentation
 PLIF/TLIF
 ALIF – failed posterolateral fusion/persistent
instability
 Decompression alone
 Elderly
 Comorbidities

27.  Pseudoarthrosis
 Persistent back pain >4-6 months
 Return of pain
 New/worsening neurologic symptom
 Persistent gait abnormality
 Most diagnostic
 Persistent lucent line at the fusion site
 Visible motion on dynamic radiograph
 Neurologic deficit
 Vascular complicatios
 Infection