Isthmic Spondylolisthesis: Symptoms and Diagnosis
Symptoms
Patient complaints include low back pain with/without buttock or thigh pain.
Symptoms are "mechanical" in nature, meaning that the pain is aggravated by
standing and walking and relieved by lying down. In addition, symptoms of spinal
stenosis (narrowed spinal canal and intervertebral foramina) are also common.
Complaints such as tired legs, numbness and tingling after walking a certain
distance are common. Symptoms are partially or completely relieved by leaning
forward or sitting down for a couple of minutes (Fig. 6).
Figure 6. Lateral x-ray illustrating lumbar vertebral
slippage
and instrumentation to stabilize the lumbosacral segment (L5-S1).
How Adult Slip Progression is Diagnosed
Serial x-rays (radiographs) of the lumbar spine may be helpful to establish
the diagnosis. Serial radiographs are x-rays taken over a period of several
years. Simple standing x-rays of the lumbar spine may suffice in patients with
a sole complaint of back pain. However, in cases with accompanying sciatica
(leg pain), these may not suffice. Further, computed tomography (CT) and magnetic
resonance imaging (MRI) are important diagnostic tools used to assess spondylolisthesis
(Fig. 7). In addition, electromyography (nerve testing) may further help to
evaluate symptoms but, it is not a mandatory diagnostic procedure in every case.
Figure 7. MRI, lateral view of lumbosacral
level indicating isthmic spondylolisthesis.