====== Lumbar degenerative spondylolisthesis ======

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Anterior [[subluxation]] of one [[lumbar]] [[vertebral body]] (VB) on another, most common ly the upper VB is anterior to the inferior one. Usually [[L5]] on [[S1]], the next most common is [[L4]] on L5.

[[Lumbar Disc herniation]] and nerve root compression with spondylolisthesis: It is rare for a herniated lumbar
disc to occur at the level of the [[listhesis]], however the disc may “roll” out as it is uncovered and
produce findings on MRI that may resemble a herniated disc which has been termed a “[[pseudodisc]].”

It is more common to see a herniated disc at the level above the listhesis.

If the listhesis does cause nerve root compression, it tends to involve the nerve exiting below the
[[pedicle]] of the anteriorly subluxed upper [[vertebra]] (e.g. if an L4–5 spondylolisthesis causes nerve root
compression, it will generally involve the L4 [[root]]). The compression is usually due to upward displacement
of the superior articular facet of the level below together with disc material, and symptoms typically resemble [[neurogenic claudication]], although true [[radiculopathy]] may sometimes occur.

There also may be a contribution from a fibrous/inflammatory mass from the nonunion.

[[Isthmic spondylolisthesis]] rarely produces [[central canal stenosis]] since only the anterior part of the
[[vertebral body]] shifts forward. May present with [[radiculopathy]] or [[neurogenic claudication]] from compression in the neural foramen, with the nerve exiting under the pedicle at that level being the
most vulnerable. May also present with low back pain. Many cases are asymptomatic
===== Classification =====

see [[Lumbar Spondylolisthesis Classification]].
----
Lumbar [[degenerative spondylolisthesis]] (DS) and [[Lumbar spinal canal stenosis]] (SPS) were originally described as separate pathoanatomic entities, though both cause narrowing of the [[spinal canal]], compression of the [[nerve root]]s, and can lead to [[neurogenic claudication]]
((Junghanns H. Spondylolisthesen ohne Spalt in Zwischengelenkstueck. Archiv fur Orthopadische Unfallchirurgie. 1930;29:118–27.))
((Verbiest H. A radicular syndrome from developing narrowing of the lumbar vertebral canal. J Bone Joint Surg [Br] 1954;37-B:230–7.)).

[[Isthmic spondylolisthesis]] rarely produces central canal stenosis since only the anterior part of the
vertebral body shifts forward. May present with radiculopathy or neurogenic claudication from compression
in the neural foramen, with the nerve exiting under the pedicle at that level being the most
vulnerable. May also present with low back pain. Many cases are asymptomatic.

===== Natural history =====

Progression of spondylolisthesis may occur without surgical intervention, but is more common following
surgery
((Tuite GF, Doran SE, Stern JD, et al. Outcome After
Laminectomy for Lumbar Spinal Stenosis. Part II:
Radiographic Changes and Clinical Correlations. J
Neurosurg. 1994; 81:707–715)).
===== Clinical features =====

[[Lumbar degenerative spondylolisthesis clinical features]]

===== Diagnosis =====

[[Lumbar degenerative spondylolisthesis diagnosis]].



===== Treatment =====

see [[Degenerative Lumbar Spondylolisthesis treatment]].

===== Outcome =====
Can produce [[lumbar foraminal stenosis]], [[lumbar spinal stenosis]].

The presence of spondylolisthesis in patients with central [[lumbar spinal stenosis]] is a [[risk factor]] for lack of [[recovery]], but not [[deterioration]]. The absence of therapeutic exercise was a risk factor for the progression of the disease
((Nikitin AS, Kamchatnov PR. [The conservative treat ment of patients with
degenerative lumbar stenosis]. Zh Nevrol Psikhiatr Im S S Korsakova.
2019;119(6):32-41. doi: 10.17116/jnevro201911906132. Russian. PubMed PMID:
31407679.
)).

===== Case series =====

[[Lumbar spondylolisthesis case series]].


===== References =====