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. Patients commonly present with lower back pain and/or neurologic symptoms. Low back pain may be positional, worsening with flexion or extension. Neurologic symptoms can include radicular pain in a specific dermatomal distribution or neurogenic claudication causing bilateral leg pain. Younger patients may be more likely to present with an isthmic spondylolisthesis, while older patients are likely to present with a degenerative spondylolisthesis. Physical examination includes an assessment of lumbar range of motion, areas of tenderness, most importantly, a thorough neurological examination to assess strength and sensation. Symptomatic patients can be evaluated with upright static and dynamic radiographs of the lumbar spine to assess the spondylolisthetic segment as well as full-length radiographs to determine overall sagittal balance. Advanced imaging, most commonly magnetic resonance imaging, can be beneficial to confirm the presence and location of nerve root compression. This chapter reviews the clinical presentation and evaluation of patients with spondylolisthesis.