Figure 512

Lateral plain films of the lumbosacral spine in (A) flexion and (B) extension. Note degenerative slip at L4-L5 during flexion (A), which is reduced in extension (B).

provide symptomatic relief. Activity modification—minimizing time spent in painful postures—can be helpful as well.

Stabilization exercises combined with pelvic tilt exercises may prove helpful for those patients willing to spend the time to master these exercises and incorporate them in their daily routine. Fitness exercises, especially those performed in the pool (balneotherapy), may also offer temporary symptomatic relief. Radiofrequency neurotomy of arthritic, painful facets can bring significant long-term relief in selected patients. Patients with severe unremitting pain and neurogenic claudication could be referred for surgery. Decompression with stabilization and fusion should be considered in these patients. The future role of disc arthroplasty in this condition is still to be determined.

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Buetler WJ, Fredrickson BE, Murtland A, Sweeney CA, Grant WD, Baker D: The natural history of spondylolysis and spondylolisthesis: 45-year follow-up evaluation. Spine 28: 1027-1035, 2003.

Collier BD, Johnson RP, Carrera GF, Meyer GA, Schwab JP, Flatley TJ, Isitman AT, Hellman RS, Zielonka JS, Knobel J: Painful spondylolysis or spondylolisthesis studied by radiography and single-photon emission computed tomography. Radiology 154: 207-211, 1985.

Deutman R, Diercks RL, de Jong TE, van Woerden HH: Isthmic lumbar spondylolisthesis with sciatica: The role of the disc. Eur Spine J 4: 136-138, 1995.

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