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Chiropractic Research Review

Spondylolisthesis and Back Pain

Spondylolisthesis, the anterior displacement of a vertebral body in relation to the segment below it, is a relatively common condition. There are five general classifications of spondylolisthesis, the most common being type I (isthmic) - stress fracture in the pars or elongation without separation.

Evidence suggests that type I spondylolisthesis is related to upright stance, with the condition perhaps representing a fatigue fracture caused by ambulatory activities.

Whether or not spondylolisthesis produces back pain is a hotly debated topic. For those who think that pain is produced by this condition, the specific mechanism for pain production remains elusive. The purpose of this study was to "observe whether a causal relationship exists between and L5/S1 isthmic spondylolisthesis and the symptoms of back pain." Subjects presenting with spondylolisthesis and a grade 1 listing at L5/S1 were divided into three groups for comparison: 57 symptomatic spondylolisthesis subjects; 29 asymptomatic spondylo- listhesis subjects; and 63 asymptomatic non-spondylolisthesis subjects (the control group).

Radiological measurements, including intervertebral disc (IVD) angle and sacral base angle (SBA) were made from film obtained from two private clinics and the Macquarie University Outpatients Clinic. Results showed that average SBA was significantly higher in symptomatic and asymptomatic patients than in non-spondylolisthesis patients. Additionally, the lumbosacral disc angle was significantly smaller in the spondylolisthesis groups compared with the non-spondylolisthesis group.

image - Copyright – Stock Photo / Register Mark

Conclusion: "The high incidence of L4/L5 hyperextension, the variability in disc angles, and the increased sacral base angulation in symptomatic spondylolisthesis patients illustrate biomechanical changes and dysfunction, and offer possible explanations for the origin of symptoms associated with spondylolisthesis."

Bull P, Hayek R, Cameron J, et al. The effects of spondylolisthesis on the lumbar spine: a cross-sectional radiological survey. Chiropractic Journal of Australia, March 2000:30(1), pp5-12. Reprints: Tel: +61 2 6921 3238; Fax: +61 2 6926 2556; e-mail: chance@wagga.net.au

Chiropractic Research Review

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