Spondylolisthesis is a condition of spinal instability, in which one vertebra slips forward or backward over the vertebra below. There are six types of spondylolisthesis based on the cause of the slip.
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Who Is at Risk?
Individuals at risk for spondylolisthesis include:
Types of Spondylolisthesis
- Increased risk in individuals who engage in certain kinds of gymnastics, weight lifting or contact sports such as football, volleyball or soccer
- Individuals with radiographic osteoarthritis
- Postmenopausal women with osteoporosis
- Those who have spondylolysis (a stress fracture in the posterior part of the vertebra)
- Those with an abnormal forward curvature of the lumbar spine
There are six types of spondylolisthesis, including:
- Degenerative spondylolisthesis — This condition usually occurs in the lumbar spine, especially at the fourth and fifth lumbar vertebrae (L4 and L5). It is the result of degenerative changes in the vertebral structure that cause the joints between the vertebrae to slip forward. It is usually accompanied by spinal stenosis, or the narrowing of the spinal canal. This type of spondylolisthesis is most common among older female patients, usually those over 60. It generally causes back pain and limitations in walking ability.
- Dysplastic or congenital spondylolisthesis — This type is caused by an abnormality of the joints of the spine. It is a defect in the posterior part of the fifth lumbar vertebra (L5) or the first sacral vertebra (S1). The abnormal orientation of the bones permits forward slippage of one vertebra on another. It is a rare condition and is frequently associated with neurologic involvement. Congenital spondylolisthesis is twice as common in women as in men. This is a condition that a patient is born with and the onset of symptoms usually occurs during adolescence.
- Iatrogenic spondylolisthesis — This type occurs in patients who have had extensive laminectomy, or decompression of the spine resulting in instability.
- Isthmic spondylolisthesis — This is the most common form of spondylolisthesis. It is caused by a bony defect or by spondylolysis, which is generally a stress fracture in the posterior part of the vertebra, called the pars interarticularis. This condition most commonly occurs in the lumbar region, at the level between the fifth lumbar vertebra (L5) and the first sacral vertebra (S1) and is not always painful. This bony defect occurs in approximately 4 percent of the population, and results from a genetic failure of bone formation.
- Pathologic spondylolisthesis — This type is the result of tumor, infection or bone disease eroding the spine, causing instability leading to slippage.
- Traumatic spondylolisthesis —This condition results from direct trauma or injury to the vertebrae. This can be caused by a fracture of the pedicle, lamina or facet joints that allows the front portion of the vertebra to slip forward.
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