WHEN TO SEE A SPINE SPECIALIST

You should seek the advice of a spine specialist if neck or back pain persists for more than two weeks or if it is progressive in intensity and/or distribution. You should seek immediate healthcare attention if neck or back pain occurs as the result of an injury or if it is associated with serious illness and/or a high fever. Additional signs and symptoms which warrant prompt medical attention include:

• Neck or back pain associated with bowel and/or bladder dysfunction
• Neck or back pain associated with extremity weakness or difficulty with coordination
• Extremity numbness or muscle weakness
• Neck or back pain that is associated with impaired walking (gait) or difficulty with balance
• Numbness, tingling and/or muscle weakness associated with a back or neck injury

SCREEENING AND DIAGNOSIS

Plain X-ray assessment may reveal displacement of a vertebral body with reference to the vertebral body below on a lateral or side view X-ray. The best diagnostic imaging tool is computerized tomography (CT). Thin slice CT with 3-D reconstruction (reformatting) is very good at detecting both the presence and the cause of spondylolithesis. MRI can be effectively used to assess associated or complicating findings such as a disc herniation, spinal stenosis, bone marrow abnormalities and to rule out a hematoma (pool of blood) which would be suggestive of a traumatic cause. A nuclear bone scan may be used to help determine whether there was a recent bone injury or fracture.

Conditions which may mimic the symptoms associated with spondylolisthesis include:

• Spondylosis
• Disc herniation
• Facet syndrome
• Spinal segment dysfunction
• Spinal myalgia
• Spinal stenosis
• Spinal fracture

PATHOLOGY

The most common cause is felt to be the result of a combination of weakened bone and repetitive trauma during the stages of development. There are conditions, which are known to increase the risk for acquiring spondylolisthesis such as surgery and degenerative disorders of the spine.  Individuals who participate in aggressive sports at a young age are more likely to develop this condition. Examples sports include gymnastics, weightlifting, rugby and football. Conditions, which may contribute to the development of spondylolisthesis, include spondylolysis, degenerative changes, tumor infection, post-operative destabilization and neuropathic arthropathy.

NATURAL HISTORY AND PROGNOSIS

Risk of progression varies form 5-30 %

Progressive spondylolisthesis occurs during skeletal development

May progressive in degree of movement (translation)