Spondylolisthesis
Spondylolisthesis is forward slippage of one vertebral body over the one below it, most often at L4-L5 and L5-S1. In children it is usually due to a pars defect (isthmic), while in adults it is degenerative. It can cause low-back pain, leg pain and difficulty walking, although many low-grade cases are asymptomatic.
最后更新: 2026-06-06
Definition
Spondylolisthesis (from the Greek for 'spine' and 'slipping') is forward displacement of a vertebral body over the vertebra beneath it. It is most common in the lumbar spine, particularly at L4-L5 and L5-S1. A defect in the narrow bony bridge called the pars interarticularis (spondylolysis), or degeneration of the disc and facet joints, predisposes to forward slippage. As the slip progresses, the spinal canal and neural foramen narrow.
Causes and Classification
By the Wiltse classification the main types are: dysplastic (congenital), isthmic (pars defect — stress fracture or elongated pars), degenerative (disc and facet degeneration, most often L4-L5), traumatic, pathological (bone metabolic disease, tumor, infection) and iatrogenic (prior surgery). The isthmic type is more common in men and athletes (gymnastics, wrestling, football), while the degenerative type predominates in postmenopausal women. A family history increases risk.
Grade of Slip (Meyerding Classification)
The amount of slip is graded against the anteroposterior diameter of the lower vertebral body: Grade I (0-25%), Grade II (26-50%), Grade III (51-75%), Grade IV (76-100%) and Grade V / spondyloptosis (over 100%, the upper vertebra fully slipped forward). Grade I-II is usually mildly to moderately symptomatic, while higher grades are associated with severe pain, deformity and neurological complications. Spino-pelvic parameters such as slip angle and pelvic incidence are also important in assessment.
Symptoms
The most frequent complaint is axial low-back pain that worsens with prolonged standing, bending and backward (extension) movement and eases with forward flexion and rest. Nerve-root compression produces radicular leg pain (the L5 root affecting the top of the foot and big toe, the S1 root the back of the leg and outer foot). With accompanying canal stenosis, leg pain on walking (neurogenic claudication) appears. Advanced cases may show muscle weakness, hamstring tightness, and postural and gait abnormalities; rarely, cauda equina syndrome is an emergency. Many low-grade slips are asymptomatic.
Diagnosis
Diagnosis is based on clinical assessment and imaging. A standing lateral radiograph shows the grade of slip; oblique views reveal a pars defect as the 'Scotty dog' sign, and flexion-extension views assess dynamic instability. MRI demonstrates nerve-root and cauda equina compression, disc disease and canal narrowing. CT best shows the pars defect and bony anatomy; when an acute pars fracture is suspected, bone scan/SPECT or STIR sequences are used. EMG helps confirm radiculopathy.
Treatment Options
For low-grade, mildly symptomatic cases the approach is conservative and controls symptoms in most patients: activity modification, weight management, core stabilization and flexibility exercises, analgesic/NSAID therapy, epidural steroid injection in selected cases, and bracing for pediatric acute pars lesions. Surgery is considered for progressive neurological deficit, cauda equina syndrome, pain unresponsive to conservative care, and high-grade or progressing slips. Surgical options include decompression, in-situ decompression plus fusion, reduction plus fusion when needed, and interbody fusion techniques (TLIF, PLIF, ALIF); minimally invasive methods are used in suitable cases.
Postoperative Course and Prognosis
After fusion surgery the hospital stay is usually a few days, with early mobilization and DVT prophylaxis. A brace may be worn for 6-12 weeks per surgeon advice, and heavy lifting and twisting are restricted. Return to office work takes about 6-8 weeks and to physical work 3-6 months. Most patients do well with conservative treatment, and appropriately selected surgical patients have high fusion success and clinical improvement. Outcomes vary individually with slip grade, age and general health.
参考文献
- Greenberg MS. Greenberg's Handbook of Neurosurgery. 10th ed. Thieme; 2023:1337-1340.
- Winn HR, ed. Youmans Neurological Surgery. 6th ed. Saunders; 2011.
- North American Spine Society (NASS) — Clinical Guidelines: Degenerative Lumbar Spondylolisthesis.
本文仅供一般参考，不能替代医疗检查。诊断与治疗决策因人而异。