الفهرس 
Morphological AnatomyOnly 14 pages are availabe for public view
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Abstract
Degenerative spondylolisthesis, also known as
pseudospondylolisthesis, results from severe localized arthritis of the facets (apophyseal joints)
of the slipped vertebrae.
The presenting features involve back pain and leg pain. The initial symptom is usually back pain,
which may radiate into the buttocks, but patients often complain of a ‘tight’ feeling in
the upper thighs. patients often have a gait disturbance, the so-called ‘tight hamstring’ syndrome.
The vertebral slippage may produce compression of the lumbar nerve roots in the neural foramen.
This causes sciatica, the symptoms of which may be indistinguishable from those due to disc
prolapse. Narrowing of the bony canal may result in clinical symptoms of ‘lumbar canal stenosis’.
Radiological investigations, including plain X-rays, CT scan and MRI, will show the type of
spondylolisthesis, the amount of slippage and the associated narrowing of the neural canals. The
degree of subluxation is commonly described by the percentage of slip (Taillard method) or assigned
a grade (I– IV) based on the number of quarters of the adjacent body spanned by the slip.
In most patients conservative therapy involving short periods of bed rest during exacerbations of
discomfort, gentle mobilizing exercises, simple analgesic medication and non- steroidal
anti-inflammatory medication will be sufficient. If
some pain persists following bed rest a period with a properly fitted lumbar brace may be of value.
Surgery involves either a laminectomy to decompress the neural structures and/or a spinal fusion to
prevent instability. A laminectomy decompresses the lumbar theca and nerve roots, usually with
satisfactory relief of lower limb symptoms. However, a laminectomy may increase the instability and
some surgeons prefer to combine a decompressive laminectomy with a spinal fusion. An
intertransverse fusion between the transverse processes has been the traditional method of
fusion, but more recently internal pedicle screw fixation and/or interbody ‘cages’ placed in the
emptied disc space between the vertebral bodies have become the preferred method.