Spondylolisthesis: "A Slipped Vertebra"
The term spondylolisthesis is used to describe several different spinal disease processes where one vertebra is out of its normal alignment with the adjacent vertebra. The term means "spine slip". This is clearly seen and measurable on routine x-rays. It should not be confused with the chiropractic community's concept of a vertebra being "out" (without any imaging abnormalities, including x-rays).
The typical appearance of spondylolisthesis is one vertebra slipping forward on the vertebra below. Retrolisthesis is a term used to describe when a vertebra is slipping backward on the vertebra below. Lateralolisthesis describes the vertebra that is displaced to the side of the vertebra below. Rotatory listhesis is a degenerative condition where a vertebra rotates on the vertebra below.
Routine standing spinal x-rays are the best way to diagnose vertebral malalignment such as spondylolisthesis. Flexion and Extension (patient bending forward and backward with maximum effort) x-rays of the spine are also helpful to assess whether the spine moves excessively and is unstable.
Often, spinal stenosis (pinched spinal nerves) accompanies spondylolisthesis and additional imaging studies are required to detect the presence of nerve compression within the spinal canal. A MRI scan is an excellent test to show the soft tissues of the spine in a way not possible with x-rays. A myelogram combined with a CT scan is another excellent way to evaluate nerve compression, especially when it is related to bone spurs and other arthritic processes which can narrow the spinal canal and compress nerves.
A CT scan by itself (without a myelogram) may be useful in diagnosing the type of spondylolisthesis caused by a stress fracture. This type, called "isthmic” spondylolisthesis, can usually be diagnosed on the basis of oblique x-rays. Occasionally, isthmic spondylolisthesis is diagnosed with a CT scan.
A bone scan can be helpful at identifying a recent stress fracture that could lead to spondylolisthesis. This has an important role in children who have back pain from an undiagnosed cause, and isthmic spondylolisthesis is suspected.
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