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Lumbar degenerative spondylolisthesis

A recently published study conducted at our research center reported the prevalence of radiographic findings in individuals with chronic low back pain presenting for a clinical trial [1]. There were several interesting findings, but here I will mention only a few regarding lumbar degenerative spondylolisthesis.

First, a brief review; degenerative spondylolisthesis occurs when a vertebrae translates (usually in an anterior direction) over an inferior vertebrae, or the sacrum [2]. Degenerative spondylolisthesis can be considered the manifestation of several physiological events that occur over time and represent an alteration (from normal) in spinal biomechanics.

At least two physiological events lead to degenerative spondylolisthesis [2]:

1. Disc degeneration in the form of disc narrowing and/or plastic deformation of annular fibers allowing translation across the inferior or supporting segment.
2. Zygapophyseal (facet) degeneration and bony remodeling to allow translation

Because the anterior and posterior elements are completely intact, degenerative spondylolisthesis has the potential to cause lumbar stenosis due to spinal canal narrowing caused by single-segment vertebral translation [3]. This is the opposite of what occurs with isthmic spondylolisthesis, which broadens the spinal canal because of the separation between anterior and posterior vertebral components [2].

Degenerative spondylolisthesis may not result in pain. Alternatively, it can be a major factor, even to the point of causing the relatively severe symptoms of neurogenic claudication [4]. In those individuals with chronic low back pain who were evaluated in our study, 51% of females and 24% of males over age 50 exhibited degenerative spondylolisthesis at 1 or more segments. Those percentages suggest the condition is very common, at least in our study population. Having this information is worthwhile to me as I consider diagnosis, which spinal manipulative procedure(s) to employ, and in determining rehabilitative or preventative exercise recommendations.

Reference List

1. Vining R, Potocki E, McLean I, Seidman M, Morgenthal AP, Goertz C: Prevelance of radiographic findings in individuals with chronic low back pain screened for a randomized clinical trial: secondary analysis. Journal of Manipulative and Physiological Therapeutics 2014, Accepted for publication.
2. Modic MT, Ross JS: Lumbar degenerative disk disease. Radiology 2007, 245(1): 43-61.
3. Jacobsen S, Sonne-Holm S, Rovsing H, Monrad H, Gebuhr P: Degenerative lumbar spondylolisthesis: an epidemiological perspective: the Copenhagen Osteoarthritis Study. Spine (Phila Pa 1976 ) 2007, 32(1): 120-125.
4. Jayakumar P, Nnadi C, Saifuddin A, Macsweeney E, Casey A: Dynamic degenerative lumbar spondylolisthesis: diagnosis with axial loaded magnetic resonance imaging. Spine (Phila Pa 1976 ) 2006, 31(10): E298-E301.

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