Spondylolisthesis refers to abnormal forward slippage of one vertebra in the spine upon another. In children and teenagers, spondylolisthesis is very often due to some aspect of dysplasia (abnormal formation) of the L5-S1 area of the spine (the lowest area of the back at the junction with the pelvis). In most cases this means that a patient was born with a slightly abnormal formation of the last lumbar vertebra (called L5) and of the sacrum. This can lead to some loss of stability in the spine and gradual slippage between L5 and the sacrum.
In most cases spondylolisthesis is more a condition than a true problem and in fact may go completely unnoticed. However, cases of repeated injury or unstable cases of spondylolisthesis may lead to progressive slippage, pain and rarely neurologic symptoms (leg cramping, pain, weakness?
There are several types of spondylolisthesis, the most common being called "isthmic spondylolisthesis" which involves a separation in the posterior portion of the vertebra. Other types in children include the pure dysplastic forms, rarely iatrogenic and traumatic types.
The initial evaluation in most cases includes a complete examination and a set of X-rays. In some cases a CT scan may be performed to clearly outline the slippage. If there is no evidence of significant instability or nerve irritation then spondylolisthesis is often treated by bracing and acitivity modification.
The first step in treatment thus often involves simple restriction of sports (spondylolisthesis is common in gymnasts, football players and weightlifters). In rare cases a spondylolisthesis is unstable and involves progressive slippage of the spine with potential hazards for the nerves. In these cases surgical treatment may be required. The goal of operative care is usually to provide stability of the Lumbo-Sacral area and to correct some degree of kyphosis that is often present.
The goal of surgery is not a complete reduction but a realignment to restore lordosis and achieve solid fusion.
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