Degenerative Spondylolisthesis

Degenerative spondylolisthesis is a common condition. It occurs in the fifth or sixth decades, mostly in women. It almost always occurs at the L4-L5 level but occasionally is seen higher up in the lumbar spine. Degenerative spondylolisthesis rarely progresses beyond stage one.

The etiology of degenerative spondylolisthesis is multifactorial. Predisposing factors include generalized joint laxity, pregnancy, sagittal facet orientation at L4-L5, and sacralization of the fifth lumbar vertebra. Disc degeneration leads to altered load distribution in the motion segment. These biomechanical changes combined with slackening of the stabilizing ligaments (due to the decreased discal height) and changes in the facet joints lead to the development of segmental instability and degenerative slip.

Clinical Presentation

Initially patients present with mechanical low back pain predominantly during standing and walking. As the degenerative processes progress, radicular symptoms may develop. With time, neu-rogenic claudication becomes debilitating. Patients are prevented from functional walking due to severe discomfort and pain in both lower extremities. The latter condition appears to be due to lumbar stenosis that is formed when degenerative changes involving the facets, vertebral body, and ligaments occur and is aggravated by the vertebral slip (Figure 5-9).

Dealing With Back Pain

Dealing With Back Pain

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