Clinical evaluation of adult patient with spondylolisthesis

Adult spondylolisthesis is the translation of one vertebra in relation to the adjacent level and can be classified into six groups: dysplastic, isthmic, degenerative, traumatic, pathologic, and post-surgical. This chapter reviews the clinical presentation and evaluation of patients with spondylolisthesis. Patients will commonly present with lower back pain. Low back pain may be positional, worsening with extension or flexion. Radicular pain or symptoms of neurogenic claudication are also commonly present. Younger patients may be more likely to present with an isthmic spondylolisthesis, while older patients, especially females, are likely to present with a degenerative spondylolisthesis. Physical examination includes an assessment of lumbar range of motion, areas of tenderness to palpation and, most importantly, a thorough neurological examination. Symptomatic patients can be evaluated with upright static and dynamic radiographs of the lumbar spine as well as full-length radiographs to assess the spondylolisthetic segment as well as sagittal balance. Advanced imaging, most commonly magnetic resonance imaging, can be beneficial to confirm the presence and location of nerve root compression.