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Evaluation of spondylolisthesis includes a patient history, a physical examination, and radiological imaging studies.

Patient History

The patient history includes questions regarding:

• Overall health of patient - history of smoking, surgery, occupation, lifestyle, lower back pain
• Duration of symptoms
• Activities that exacerbate the pain
• Location of pain
• Exercise history, sports participation and relation to pain
• Acute or gradual onset of pain

Physical Examination

During the physical examination, the physician will pay particular attention to the following:

• Body habitus - the physique or body build
• Body posture
• Spinal alignment
• Spinal mobility
• Presence of muscle spasm
• Lower spine range of motion
• Pain on flexion or extension - patient may have pain raising legs straight up
• Positions that provoke the pain or radiculopathy
• Hamstring muscle tightness
• Muscle strength in legs
• Reflexes and sensation in the legs
• Dermatomes - areas of the skin supplied by nerve fibers originating from a single dorsal nerve root. Evaluation is important in order to recognize nerve root damage or radiculopathy. Radiculopathy is suspected when there is loss of sensation in a dermatome.
• Gait pattern - to assess the degree to which the patient walks with knees flexed, lumbar stiffness, and lordosis or kyphosis

• Neurological signs - these are present in up to one-third of individuals with spondylolisthesis and may include:

  • atrophy of muscle
  • reflex changes
  • weakness
  • bowel/bladder symptoms

In patients with high-grade spondylolisthesis, the doctor will evaluate:

• Clinical deformity
• Postural alignment
• Spinal mobility
• Neurological signs and symptoms

In adults with low grade spondylolisthesis, there is usually minimal or no gait disturbance noticeable since the deformity is longstanding and the patient has usually unknowingly compensated for gait disturbances. The source of pain is mechanical and is worsened by activity so relief usually comes with rest, whereas, with high grade spondylolisthesis, there is more neurological involvement making pain relief more difficult to achieve.

Imaging Studies

Imaging (radiologic) studies are extremely valuable for visualizing the degree of vertebral slip as well as stress injury or fracture of the pars. An X-ray is usually the first radiological image taken since it clearly defines the spinal structures and their relative positions. Plain lumbosacral X-rays (anterior, posterior, lateral, and oblique views) often demonstrate cracks or fractures in the pars interarticularis (sometimes called the "Scottie dog" sign on an oblique X-ray).

A standing, lateral x-ray of the lumbosacral spine is used to determine:

• Severity or magnitude of forward slippage of the vertebra by the Meyerding scale

• Degree of slip angle - the higher the degree of the slip angle, the more serious the problem and the higher the chance for additional slippage. Measurement of the slip angle determines the degree of lumbosacral kyphosis (outward curvature of the spine). The normal angle of the lower spine is slightly lordotic (inwardly curved) but with high-grade spondylolisthesis, the angle is either neutral (totally flat) or kyphotic (outwardly curved). The more severe the angle, the greater the kyphosis. Some individuals present with signs of scoliosis (sideward curvature above the lumbosacral area. A high slip angle is associated with:

  • greater degree of spinal instability