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WWW.SPINAUNIVERSE.COMSpondylolisthesis occurs when one vertebra slips forward in relation to an adjacent vertebra, usually in the lumbar spine. The symptoms that accompany a spondylolisthesis include pain in the low back, thighs, and/or legs, muscle spasms, weakness, and/or tight hamstring muscles. Some people are symptom free and find the disorder exists when revealed on an x-ray. In advanced cases, the patient may appear swayback with a protruding abdomen, exhibit a shortened torso, and present with a waddling gait.

Spondylolisthesis can be congenital (present at birth) or develop during childhood or later in life. The disorder may result from the physical stresses to the spine from carrying heavy things, weightlifting, football, gymnastics, trauma, and general wear and tear. As the vertebral components degenerate the spine's integrity is compromised.

Another type of spondylolisthesis is degenerative spondylolisthesis, occurring usually after age 50. This may create a narrowing of the spinal canal (spinal stenosis). This condition is frequently treated by surgery.

Diagnosis of Spondylolisthesis

A routine lateral (side) radiograph taken while standing confirms a diagnosis of a spondylolisthesis. The x-ray will show the translation (slip) of one vertebra over the adjacent level, usually the one below.

Using the lateral (side) x-ray, the slip is graded according to its degree of severity. The Myerding grading system measures the percentage of vertebral slip forward over the body beneath. The grades are as follows:

Grade 1: 25%Grade 2: 25% to 49%Grade 3: 50% to 74%Grade 4: 75% to 99%Grade 5: 100%*

Non-Surgical TreatmentIf the spondylolisthesis is non-progressive, no treatment except observation is required. Symptoms often abate once precipitating activities cease. Conservative treatment includes 2 or 3 days of bed rest, restriction of activities causing stress to the lumbar spine (e.g. heavy lifting, stooping), physical therapy, anti-inflammatory and pain reducing medications, and/or a corset or brace. A physician may prescribe a custom-made corset or brace. These are made by an orthotist, a professional who takes the patient's precise body measurements, which may include making a cast from which the molded orthoses is made.

Spine SurgerySurgical intervention is considered when neurologic involvement exists or conservative treatment has failed to provide relief from long-term back pain and other symptoms associated with spondylolisthesis.

A spine surgeon decides which surgical procedure and approach (anterior/posterior, front or back) is best for the patient. His decisions are based on the patient's medical history, symptoms, radiographic findings, as well as the grade and angle of the vertebral slip. A variety of surgical treatment options are utilized. You should discuss what is best for your condition with your spine surgeon.

RecoveryWhether the treatment course is conservative or surgical, it is important to closely follow the instructions of your physician and/or physical therapist. Avoid heavy lifting, stooping, or certain sports such as football or high impact exercise (i.e. running, aerobics). Any doubts concerning vocational and recreational restrictions should be discussed with your physician and/or physical therapist. They will be able to suggest safe alternatives to help reduce the risk of further back problems. Keep your weight close to ideal, continue to follow the exercise program designed by your physical therapist at home, learn how to pick up things off the floor correctly, as well as other 'safe' movements. Symptoms Patient complaints include low back pain with/without buttock or thigh pain. Symptoms are "mechanical" in nature, meaning that the pain is aggravated by standing and walking and relieved by lying down. In addition, symptoms of spinal stenosis (narrowed spinal canal and intervertebral foramina) are also common. Complaints such as tired legs, numbness and tingling after walking a certain distance are common. Symptoms are partially or completely relieved by leaning forward or sitting down for a couple of minutes (Fig. 6).

Figure 6. Lateral x-ray illustrating lumbar vertebral slippage and instrumentation to stabilize the lumbosacral segment (L5-S1). How Adult Slip Progression is Diagnosed Serial x-rays (radiographs) of the lumbar spine may be helpful to establish the diagnosis. Serial radiographs are x-rays taken over a period of several years. Simple standing x-rays of the lumbar spine may suffice in patients with a sole complaint of back pain. However, in cases with accompanying sciatica (leg pain), these may not suffice. Further, computed tomography (CT) and magnetic resonance imaging (MRI) are important diagnostic tools used to assess spondylolisthesis (Fig. 7). In addition, electromyography (nerve testing) may further help to evaluate symptoms but, it is not a mandatory diagnostic procedure in every case.

Figure 7. MRI, lateral view of lumbosacral level indicating isthmic spondylolisthesis. Continue this article...

Isthmic Spondylolisthesis: Adult Slip ProgressionSpondylolisthesis: Treatment, Restrictions, Bracing, MedicationSpondylolysisArticle written 12/09/2003Published online 01/21/2004Last updated 12/12/2005

Isthmic spondylolisthesis is an important cause of back pain and disability in children, adolescents, and adults. The natural history and clinical presentation of isthmic spondylolisthesis is distinct from other etiologies of spondylolisthesis. Dr. Floman has made an important contribution to our understanding of isthmic spondylolisthesis in adults by demonstrating a significant incidence of deformity progression in adulthood, and suggesting a mechanism to explain the variable onset of pain associated with spondylolisthesis in adults. (1) Operative management in the patient with symptomatic isthmic spondylolisthesis is clearly superior to non-operative care. (2) However, there remains significant variation in surgical strategies, and limited evidence to guide decision-making.In low-grade isthmic spondylolisthesis, the role of anterior column support has not been well-defined, and there is little consensus on circumferential arthrodesis compared with posterolateral fusion alone. In fact, a beneficial effect of instrumentation has not been clearly established in these cases. (3) In contrast, in grade 3 and 4 spondylolisthesis, there is strong evidence to suggest improved rates of arthrodesis and better clinical outcome with structural support of the anterior column. (4) In high-grade spondylolisthesis, partial reduction and transosseous fixation has resulted in reliably good clinical outcomes. (5) The role of complete reduction and restoration of lumbopelvic relationships remains to be established.

Dr. Floman's observation that the surgical treatment of symptomatic isthmic spondylolisthesis is a reliable procedure for the treatment of pain and dusfunction is confirmed by our published and unpublished data. (5,6,7) Further investigations including multicenter prospectve clinical studies are required to establish an evidence-based consensus approach regarding the role of interbody arthrodesis in low-grade spondylolisthesis, the role of reduction of slippage and restoration of lumbosacral lordosis in high-grade spondylolisthesis, and the role of in-situ arthrodesis in adults.

What Is Spondylolisthesis?I. DefinitionThe word spondylolisthesis derives from two parts - spondylo which means spine, and listhesis which means slippage. So, a spondylolisthesis is a forward slip of one vertebra (i.e., one of the 33 bones of the spinal column) relative to another. Spondylolisthesis usually occurs towards the base of your spine in the lumbar area.

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Fig. 1Fig. 2 Fig. 3Fig. 4

II. Spondylolisthesis DescriptionSpondylolisthesis can be described according to its degree of severity. One commonly used description grades spondylolisthesis, with grade 1 being least advanced, and grade 5 being most advanced. The spondylolisthesis is graded by measuring how much of a vertebral body has slipped forward over the body beneath it.

Grade 125% of vertebral body has slipped forward

Grade 250%

Grade 375%

Grade 4100%

Grade 5Vertebral body completely fallen off (i.e.,spondyloptosis)

Part 3.

How Do People Get Spondylolisthesis?Approximately 5-6% of males, and 2-3% of females have a spondylolisthesis. It becomes apparent more often in people who are involved with very physical activities such as weightlifting, gymnastics, or football. Males are more likely than females to develop symptoms from the disorder, primarily due to their engaging in more physical activities. Although some children under the age of five may be pre-disposed towards having a spondylolisthesis, or may indeed already have an undetected spondylolisthesis, it is rare that such young children are diagnosed with spondylolisthesis. Spondylolisthesis becomes more common among 7-10 year olds. The increased physical activities of adolescence and adulthood, along with the wear- and-tear of daily life, result in spondylolisthesis being most common among adolescents and adults.

I. Types of Spondylolisthesis.Different types of spondylolisthesis may be caused in a different ways. Some examples are:

Developmental SpondylolisthesisThis type of spondylolisthesis may exist at birth, or may develop during childhood, but generally is not noticed until later in childhood or even in adult life.

Acquired SpondylolisthesisAcquired spondylolisthesis can be caused in one of two ways: i. With all of the daily stresses that are put on a spine, such as carrying heavy items and physical sports, the spine may wear out (i.e., degenerate). As the connections between the vertebrae weaken, this may lead to a spondylolisthesis. ii. A single or repeated force being applied to the spine can cause a spondylolisthesis; for example, the impact of falling off a ladder and landing on your feet, or the regular impact to the spine endured by offensive linemen playing football.

II. What Symptoms Might I Notice?Many people with a spondylolisthesis will have no symptoms, and will only become aware of the problem when it is revealed on an x-ray for a different problem. However, there are several symptoms that often accompany spondylolisthesis:

Pain in the low back, especially after exercise

Increased lordosis (i.e., swayback).

Pain and/or weakness in one or both thighs or legs

Reduced ability to control bowel and bladder functions

Tight hamstring musculature

In cases of advanced spondylolisthesis changes may occur in the way people stand and walk; for example, development of a waddling style of walking. This causes the abdomen to protrude further, due to the lowback curving forward more. The torso (chest, etc.) may seem shorter; and muscle spasms in the lowback may occur.

How Is Spondylolisthesis Treated? The grade of slip (grades 1-5) and the symptoms will help determine the type of treatment that will be suitable. The doctor will consider the following options:

I. No treatmentApproximately 5% of the population has a spondylolisthesis, most of whom will never need any treatment as their spondylolisthesis is stable, and non-progressive. For adults, treatment is only recommended for those patients who have symptoms of pain and disability. For children, treatment is necessary if they have pain, and when the forward vertebral slip is progressing. Observation is adequate for the adult who has no symptoms or the child who has a minimal spondylolisthesis and no symptoms.

Most patients with spondylolisthesis should avoid activities that might cause more stress to the lumbar spine, such as heavy lifting and sports activities like gymnastics, football, competitive swimming, and diving. Patients, or their parents, must discuss their daily activities and hobbies with their physician to see if they are all right to continue.

II. Bed rest/activity restrictionsBed rest following an injury to the back is used less and less because of the risk of deconditioning (e.g., loss of muscle tone which delays recovery). Ten years ago, one of your friends may have had a similar back problem and was placed on bed rest for at least ten days. We now know that a shorter period of time, such as two to three days followed by a guided physical therapy program is a better solution to back pain.

Once the spondylolisthesis has been recognized, treatment often consists of a short rest period (two to three days) followed by a physical therapy program by a registered physical therapist who has an understanding of spondylolisthesis.

There should be restriction of heavy lifting, excessive bending, twisting or stooping and avoidance of any work or recreational activities that causes stress to the lumbar spine. Your physician will outline a rehabilitation program to return you to your activities as soon as possible.

It is in your best interest to closely follow the activity program as outlined by your physician, nurse, or therapist to restore your best level of functioning as soon as possible. If your work requires heavy lifting, bending, or stooping, you will not be able to return to that type of work immediately. Specific work restrictions should be discussed with your employer so that a less demanding job may be found for you.

Remember, participating in daily activities are important to both your long-term physical and emotional well-being. While you may not be allowed to participate in some of your favorite sports activities, your physician, nurse, or therapist can help you identify activities that you can participate in, such as swimming, walking in water (i.e., hydro-therapy), and land walking, in addition to your physical therapy program.

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Fig. 5

III. MedicationMany medications are available to help reduce pain. Your physician may prescribe their use, generally to reduce:

i. inflamation ii. muscle spasms iii. painIV. Corset / BraceIn certain situations a corset or brace is useful to provide additional support to the spine. This support may decrease muscle spasm and pain.

Corsets consist of soft fabric, and may include rigid supports. Corsets can be obtained either through your physician, orthotist (i.e., a person trained to make orthopaedic braces), medical supply company, or pharmacy. Normally a corset is worn when you are up and about, but is often not necessary when you are lying in bed.

Braces are made of plastic and can be ready-made or custom fit. Ready-made braces are appropriate in those patients whose lumbar spine has a near normal contour. If there is a marked forward slip of your vertebra, ready-made braces are often difficult to fit and wear. Some physicians opt for custom-made lumbar braces (orthoses) for all of their patients with spondylolisthesis.

If you require a custom-molded orthoses you will need to see an orthotist. The orthotist will take measurements and apply a cast to make a mold of your body. A custom brace will then be made for you.

When you are first given your brace, you will be advised on: how to get in and out of your brace

increasing the amount of time you spend in your brace each day until your brace schedule is achieved

watching out for skin irritation (some redness is expected under the brace). If any sores on the skin are noted, remove your brace and contact your physician, nurse, or orthotist immediately for further skin-care instructions.

The brace will be uncomfortable at first. It will take several days for you to begin to like your brace and the support that it gives your spine. Just like getting new dental braces or new shoes, it takes a while to feel comfortable.Your brace should be worn under your clothing. Wearing your brace over clothing will cause increased pressure where waistbands, buckles, snaps, and buttons can cause skin irritation and sores. You will need to wear a cotton undershirt that is snug fitting under your brace to absorb moisture and prevent skin chaffing. In warm climates you may need to change the T-shirt a couple of times per day to remain comfortable. Underpants and shorts should be worn over the brace to aid in bathroom activities. Bring loose-fitting clothing such as a jogging suit when you go to pick up your brace to be sure that the clothes will go over the brace.

Your physician and nurse will explain how long you will need to wear your brace each day and how long it is expected that you will continue to need your brace. Be sure that you understand your brace schedule and adhere to it as recommended by your health-care team. They will tell you if you are able to remove your brace on special occasions. This will be based on several factors, including your diagnosis, how long you have been under treatment, and physician preference.

V. SurgerySurgery may be recommended for your condition if nonoperative measures (e.g., rest, therapy, bracing), have not improved your condition.

Surgeons may try conservative approaches in some cases, such as bracing, before proceeding to surgery. In the most advanced cases surgeons will probably recommend surgery as the first course of treatment.

This decision to do surgery is based on your symptoms, x-rays, and failure of conservative treatment. It is important that you understand why your physician is recommending a treatment. It is quite common for a spinal patient to seek another opinion regarding treatment. If this will make you feel more comfortable with your treatment program, do not hesitate to ask your physician for the name of another physician who handles similar spinal problems.

The goals of surgery are to remove pressure on spinal nerves (i.e., decompression), and to provide stability to the lumbar spine. In most cases of spondylolisthesis, lumbar decompression would need to be accompanied by uniting one spinal vertebra to the next (i.e. spinal fusion) with spinal instrumentation (i.e., implants that are often used to help aid the healing process). Surgery can be performed from the back of your spine (i.e., posterior) or from the front of the spine (i.e., anterior). Your spinal surgeon will review your particular problem with you and explain what type of surgery you need.

Part 5.

What Can I Expect If I Need Surgery?I. Preoperative preparationPrior to your surgery your physician and/or nurse should thoroughly explain to you the planned surgical procedure, the in-hospital routine, postoperative recovery/rehabilitation, and long-term activity restrictions.

Prior to your surgery it is to your benefit to be as active as possible. Pain will often limit the amount and type of exercises that you can do, but simple activities will help you build your stamina and strength prior to surgery. Such preoperative strengthening will help you rehabilitate after surgery. Ask your physician or nurse for directions on preoperative conditioning.

Most surgeries for spondylolisthesis will require blood transfusions during the surgery to replace the blood lost during the surgical procedure. Most doctors will ask patients to donate blood for themselves during the weeks prior to surgery. A blood-donation program will be outlined for you by your physician or nurse.

Immediately prior to your surgery you should meet with your physician or physician's staff once more to go over the surgical procedure, potential complications of the surgical procedure, and sign the surgical consent forms. If you have any questions regarding the planned surgery, be sure to have them answered at this time.

Prior to surgery, complete medical evaluation and appropriate laboratory studies (for example, blood and urine analysis), chest x-rays, and EKGs (i.e., monitoring of your heart) will be obtained. Those specific tests will be based on your hospital's protocols, as well as your health history. If you have any medical conditions, or are taking any medications, bring this to the attention of your surgeon and discuss your surgery with your medical doctor to be sure that you are prepared to proceed with surgery.

If you are a smoker, it would be best that you permanently stop smoking prior to your surgery. You know that smoking is not good for your lungs and heart. There is also scientific data available to show that people who smoke have less of a chance of healing spinal fusions.

As your surgical day draws near, should you develop any cold or flu symptoms, open skin sores/cuts or have any dental problems such as bloody gums or abscesses, you should notify your surgeon or nurse immediately. If there is any concern for an infection elsewhere in your body, elective spinal surgery will be postponed until you are well. This will be disappointing for you and your family but may be necessary for your well-being.

You will be admitted to the hospital on the morning of your surgery. Your Same-Day Admission nurses will work closely with your surgeon to give you the directions you will need for the day of your surgery. Typically, you will not be able to eat or drink after midnight the night before your surgery. Additional instructions may be necessary depending on your procedure, so listen carefully to your pre-operative instructions and follow them closely.

Spondylolysis

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Degenerative Spondylolisthesis of the Lumbar Spine Spondylolisthesis: Back Condition and Treatment Spondylolisthesis

Spondylolysis is a specific defect in the connection between vertebrae, the bones that make up the spinal column. This defect can lead to small stress fractures (breaks) in the vertebrae that can weaken the bones so much that one slips out of place, a condition called spondylolisthesis. Spondylolysis is a very common cause of low back pain. The word spondylolysis comes from the Greek words spondylos, which means spine or vertebra, and lysis, which means a break or loosening.

What are the symptoms of spondylolysis? Many people with spondylolysis have no symptoms and dont even know they have the condition. When symptoms do occur, low back pain is the most common. The pain usually spreads across the lower back, and might feel like a muscle strain. The pain is generally worse with vigorous exercise or activity. Symptoms often appear during the teen-age growth spurt. The typical age of a person diagnosed with spondylolysis is 15 to 16 years.

What causes spondylolysis? Spondylolysis results from a weakness in a section of the vertebra called the pars interarticularis, the thin piece of bone that connects the upper and lower segments of the facet joints. Facet joints link the vertebrae directly above and below to form a working unit that permits movement of the spine.

The exact cause of the weakness of the pars interarticularis is unknown. One theory points to genetics (heredity) as a factor, suggesting that some people are born with thin vertebrae, which place them at higher risk for fractures. Another theory suggests that repetitive trauma to the lower back can weaken the pars interarticularis.

How common is spondylolysis? Spondylolysis affects about 3 percent to 7 percent of Americans. The condition is a common cause of low back pain in children and the most likely cause of low back pain in people younger than 26 years of age. Spondylolysis is more common in children and teens participating in sports that place a lot of stress on the lower back or cause a constant over-stretching (hyper-extending) of the spine, such as gymnastics, weightlifting, and football. It is seen more often in males than in females.

How is spondylolysis diagnosed? Often, a health care provider will suspect spondylolysis after an evaluation that includes a complete medical history and physical examination. An X-ray of the lower back can show any fractured vertebra and confirm the diagnosis.

A computed tomography (CT) or magnetic resonance imaging (MRI) scan might be needed to detect very small fractures. A CT or MRI scan might also be used to rule out other conditions that might be contributing to the pain, such as a herniated (bulging) disc or pinched nerve.

How is spondylolysis treated? Initial treatment for spondylolysis is always conservative, and is aimed at reducing pain, permitting the fracture to heal, and returning the person to normal function. The person should take a break from sports and other activities until the pain subsides. An over-the-counter non-steroidal anti-inflammatory drug (NSAID), such as ibuprofen, might be recommended to help reduce pain and inflammation (irritation and swelling). Stronger medications might be prescribed if the NSAIDs do not provide relief. A program of exercise and/or physical therapy will help increase pain-free movement, and improve flexibility and muscle strength.

In more severe cases of spondylolysis, a brace or back support might be used to help stabilize the lower back as the fracture heals. Epidural steroid injections in which medication is placed directly in the space surrounding the spine might also help reduce inflammation and ease pain.

What complications are associated with spondylolysis? The pain of spondylolysis can lead to reduced mobility and inactivity. Inactivity can, in turn, result in weight gain, loss of bone density, and loss of muscle strength and flexibility in other areas of the body. In addition, spondylolysis can progress until one or more vertebrae slip out of place (spondylolisthesis).

What is the outlook for people with spondylolysis? Conservative treatment rest, medication, exercise, and bracing is often successful at relieving pain and swelling, especially when treatment is started early. About 73 percent of people have a significant reduction in pain and can return to normal activities following early treatment of spondylolysis.

Can spondylolysis be prevented? Although spondylolysis might not be preventable, there are steps you can take to reduce the risk of fractures. Seek medical attention if you suffer a back injury or have significant low-back pain. Early treatment of spondylolysis often results in the best outcomes. Keeping your back and abdominal muscles strong can help support the lower back and prevent future stress fractures. If you have spondylolysis, it is important to choose activities and sports that do not place your lower back at risk for injury. Swimming and biking are possible options.

Cleveland Clinic Health Information CenterCopyright 2005 Cleveland Clinic Foundation. All rights reserved - Used by Permission.

This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition.

WWW.WIKIPEDIA.COMSpondylolisthesis (not to be confused with spondylosis or spondylolysis) is an anteroposterior translatory movement of two spinal vertebrae in relationship to each other caused by instability between the two involved vertebrae. The instability can be caused by degenerative changes of the facet joints, or by congenital or traumatic disruption of the pars interarticularis of the upper of the two vertebrae. It occurs most commonly in the lumbar spine.

Contents

[hide] 1 Developmental anatomy

2 Pathology

3 Symptomatology

4 Treatment

5 External links

[edit] Developmental anatomyIn the very early stages of fetal development, all bones are initially represented as cartilaginous precursors; as in utero tissue differentiation progresses bone comes to form within this cartilage; a process called ossification. This occurs in specific and consistent sites within the forming bones, and the areas in which it takes place are called ossification centres.A fully formed vertebra consists of the centrum, the main weight-bearing part of the bone, and the dorsal arch, which surrounds the spinal cord and the posterior part of which can be felt externally. There are also lateral processes to which spinal muscles are attached, and superior and inferior articular processes which form joints with the vertebrae above and below.

In the fetus, three ossification cenres form in each vertebra; one in what will become the centrum, and one in each side of the dorsal arch. During development these centres normally ossify and fuse together to form a normal vertebra. Occasionally, however, for reasons which are presently unknown, the ossification centres fail to fuse. When the dorsal arch fails to fuse with the centrum the condition created is called spondylolysis. If the two dorsal arch centres fail to fuse the condition resulting is called spina bifida.

Spondylolysis also runs in families and is more prevalent in some populations, suggesting a hereditary component such as a tendency toward thin vertebral bone.

Spondylolysis is the most common cause of spondylolisthesis. The hereditary factor mentioned above is quite notable, since the frequency of spondylolisthesis in Eskimos is 3050%.

Trauma can also cause spondylolysis. It is more common in gymnasts, particularly where the spine is often loaded in extreme extension, such as when landing on the feet. This places extreme stress on the dorsal arches, acting like a nutcracker.

[edit] PathologySimple spondylolysis is an asymptomatic condition detectable only by specialized X-ray or Magnetic Resonance Imaging (MRI) techniques. As the centrum of the affected vertebra is connected to the dorsal arch only by fibrous tissue, however, there is a weakness present. There is a potential for this fibrous union to become stretched, either by major or by minor injury or indeed just by the ongoing strain involved in supporting the weight of the body while standing upright.

The degree of slippage of spondylolisthesis is graded:

Grade 1 is 0-25%

Grade 2 is 25-50%

Grade 3 is 50-75%

Grade 4 is 75-100%

Over 100% is Spondyloptosis, when the vertabra completely falls off the supporting vertabra.

When this disruption occurs the anatomy of the intervertebral joints dictates that the centrum of the defective vertebra moves forward in relation to the vertebra below it, while the dorsal arch remains correctly located. This condition is now a true spondylolisthesis.

A spondylolisthesis can be stable or unstable, depending on posture and loading. It can be symptomatic or asymptomatic.

[edit] SymptomatologyThe condition will almost invariably cause back pain, which will be worse during activity, which may feel like a muscle strain. The distortion of the anatomy of the back makes compression of one or more lumbar nerve roots likely, which will cause sciatica and possibly disturb bladder control or bowel function. In extreme cases, particularly in an upper lumbar lesion, pressure on the whole nerve bundle within the spinal canal may lead to paralysis of the lower limbs. This condition is known as cauda equina syndrome, and acute treatment is imperative, as delay can result in lifelong handicaps.

Typical physical changes that occur in an individual with spondylolisthesis will be a general stiffening of the back and a tightening of the hamstrings, with a resulting change in both posture and gait. The posture will typically give the appearance that the individual leans forward slightly and/or that they are suffering from lordosis. In addition, the lateral lumbar view demonstrates a unique "L"-shaped or "tabletop" appearance as the anterior pelvic distortion and slip angle increase . As the slip angle of the involved vertabra increases, the likelihood of the continued slippage and neurological compromise increases. The gait of the individual may change to give the appearance of more of a "waddle" than a walk, where the individual rotates the pelvis more due to the decreased mobility in the hamstrings. A result of the change in gait is often a noticeable atrophy in the gluteal muscles due to lack of use.

[edit] TreatmentBed-rest will relieve the symptoms to some extent, but will not be effective in terms of the production of a cure. Similarly, pain killing or anti-inflammatory medication or physiotherapy have only a temporary palliative effect. The only effective long-term curative treatment, if symptoms are sufficiently severe to warrant it, is by reconstructive surgery and fusion of the affected vertebra to its lower neighbour. As the development of a spondylolisthesis will commonly destroy the intervertebral disc, this will usually also need to be removed during the same surgical procedure. The indications and optimal technique for surgery are not clear as well done studies have not been conducte