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Spondylolisthesis


KEY FACTS

Terminology

  • Anterolisthesis: Anterior displacement of vertebral body relative to 1 below

  • Retrolisthesis: Posterior displacement of vertebral body relative to 1 below

Imaging

  • Lateral flexion and extension to evaluate for instability

    • Napoleon's-hat sign on AP plain film

    • Instability uncommon in degenerative listhesis

      • –

        90% of normal volunteers show 1-3-mm translation on flexion-extension radiographs

  • Spondylolysis may be difficult to identify on MR

    • T1-weighted sagittal images critical

    • CT for definitive diagnosis of subtle fracture

Pathology

  • Degenerative spondylolisthesis (DS)

    • Degenerative retrolisthesis associated with disc degeneration

    • Sagittal oriented facets more likely to have DS

  • Spondylolysis (isthmic)

    • Bilateral in 80%

  • Postsurgical: Loss of posterior element stability

  • Dysplastic: Small L5 body leading to pars lysis

  • Trauma: Severe to produce vertebral body displacement

  • Pathologic: Underlying tumor with instability

Clinical Issues

  • 9.2% overall complication rate for treatment of spondylolisthesis

    • Complications related to higher-grade spondylolisthesis, DS > isthmic, older age (> 65)

  • DS + stenosis treated surgically show greater improvement in pain and function over 4 years compared with nonsurgical treatment

Anteroposterior radiograph shows Napoleon's-hat sign. The hat is inverted, with the crown
representing the anterior cortex of vertebral body and the brim
representing the transverse processes.

Sagittal T1WI MR shows postoperative spondylolisthesis following lumbar laminectomy
. There are advanced degenerative changes of the L4-L5 intervertebral disc space
with anterior subluxation of L4 on L5.

Sagittal T2WI MR shows grade I spondylolisthesis of L4 on L5
, with intervertebral disc degeneration and associated fatty endplate change. There is also degeneration of the interspinous ligament
.

Sagittal T2WI MR shows a grade I spondylolisthesis of L4 on L5 with resultant severe foraminal stenosis
.

TERMINOLOGY

Synonyms

  • Degenerative spondylolisthesis (DS)

Definitions

  • Displacement of vertebral body, described relative to inferior vertebra

    • Anterolisthesis: Anterior displacement of vertebral body relative to one below

    • Retrolisthesis: Posterior displacement of vertebral body relative to one below

    • Spondyloptosis: Vertebral body displaced completely anteriorly, with inferior displacement to level of one below

  • Degenerative spondylolisthesis describes anterior slippage of vertebral body on another in presence of intact neural arch

IMAGING

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