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Grade 1 spondylolisthesis, or a slipped disc, is a spinal condition that can be very painful. When one vertebra slips forward over the other, the result is uncomfortable friction exacerbated by motion. While pain is sometimes confined to the area of slippage, a slipped disc can also put pressure on adjacent nerve roots, causing numbness, tingling, and/or weakness in the extremities.
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In many cases, spondylolisthesis is congenital, that is, present at birth. Specific risk factors for congenital isthmic spondylolisthesis are not known. Acquired spondylolisthesis may be caused by excessive repetitive stress, such as might occur in a competitive athlete.
2. Beutler WJ, et al. The Natural History of Spondylolysis and Spondylolisthesis: 45-Year Follow-up Evaluation. Spine 15 May 2003; 28(10):1027-1035.
What Causes a Spondylolisthesis
In Spondylolisthesis with a significant slip, a step-off at the lumbosacral junction is palpable, motion of the lumbar spine is restricted, and hamstring tightness is evident on straight leg raising. As the vertebral body displaces anteriorly, the individual assumes a lordotic posture above the level of the slip to compensate for the displacement. Adults may have objective signs of nerve root compression, such as motor weakness, reflex change, or sensory deficit. These signs are seldom seen in children.
Isthmic vs Degenerative Spondylolisthesis
Severe trauma to the lumbar spine means a major, high impact, direct injury to the lumbar spine which produces immediate lumbar pain and precludes unaided ambulation for a period of at least 2 weeks, and is associated with other fractures and/or significant soft tissue injuries. Examples are as follows:
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Spondylolisthesis appears to be acquired after infancy as no cases of congenital isthmic defects have been found in the fetus. (2,10) Its appearance is first noted at ages 5-7 years with peak incidence around 10 years of age. (3,5) Boys are twice as likely as girls to have spondylolisthesis. (7,9) Degenerative spondylolisthesis is most commonly found over the age of 65 years, and L4 is the most common level of involvement. (11) Unlike pars defect-caused spondylolisthesis, the degenerative form is more common in women. (11,24) Disability due to spondylolisthesis does not appear to be greater than those with “non-specific” lower back pain. (14)
Spondylolisthesis Treatment, Surgery & Symptoms
Spondylolysis and Spondylolisthesis usually cause no symptoms in children; however, many seek medical evaluation because of a postural deformity or gait abnormality. Pain most often occurs during the adolescent growth spurt and is predominantly backache, with only occasional leg pain. Symptoms are exacerbated by high activity levels or competitive sports and are diminished by activity restriction and rest. The back pain probably results from instability of the affected segment, and the leg pain is usually related to irritation of the L5 nerve root.
Learn about the types and symptoms of spondylolisthesis
The most frequent site of pars defect spondylolisthesis is L5 where 70% to 90% are found. (4,23) The next most common site is 4L where 25% are found. (4,23). L1 to L3 and C5 to C7 are the location of 2% to 3% each. (23) In the chiropractic office, isthmic spondylolisthesis is typically seen at L5 and degenerative spondylolisthesis at L4/L5. At times, one finds both a degenerative L4 and isthmic L5 spondylolistheses in the elderly patient.