degenerative spondylolisthesis model

Degenerative spondylolisthesis 1: general principles

Goal of the Study?

In this paper 1, the authors review the general principles of degenerative spondylolisthesis, including the diagnosis, characteristics, management and treatment.


What is degenerative spondylolisthesis?

Degenerative spondylolisthesis results from the progression of degenerative changes in the intervertebral disc (IVD) and facet joints that lead to destabilizing one or more vertebral segments. The term degenerative spondylolisthesis was first used in 1964 by Newman and was initially related to slipping of the anterior vertebral body in the lumbar region of the elderly female population. Spondylolisthesis was further classified in 1963 by Wiltse, Newman and Macnab into six categories, with degenerative spondylolisthesis defined as Class III.



Who does it impact and what are the symptoms?

Degenerative spondylolisthesis predominantly impacts elderly female patients with a ratio of 5:1 compared to men and is generally found in those over 50 years of age. Black women are three times more likely than Caucasian women to develop the condition. While there has been no correlation between body mass index (BMI) and degenerative spondylolisthesis in men, there is a significant relationship between BMI and the development of L4 listhesis in women. 

In degenerative spondylolisthesis, vertebral slipping usually occurs in the L4-L5 and rarely exceeds 30% of the vertebral body’s anteroposterior diameter. This condition may be asymptomatic, and there is no clear relationship between symptoms and the degree of slipping. However, the degree of degeneration does increase the risk of progression to lumbar spinal stenosis and the possible presentation of clinical symptoms. When there are symptoms, the most common is low back pain, with or without radicular pain. Neurogenic claudication occurs in 75% of patients. As slipping progresses, facet hypertrophy, thickening of the yellow ligament, and disc bulging can increase compression and sometimes trigger cauda equina syndrome symptoms. This can then disrupt motor and sensory function to the lower extremities and bladder.  


Diagnosis and Treatment?

Most often, radiography is the first approach to diagnosis, with a standing lateral radiograph to evaluate instability in the flexion and extension. If neurological symptoms are present, an MRI is used as this tool can assist in evaluating the spinal cord and nerve roots and the assessment of disc degeneration. 

First-line treatment generally includes pain management with anti-inflammatories and analgesics and, or physiotherapy. Surgical intervention is only required on approximately 10-15% of patients.