Female (nearing retirement) presents to the clinic with back pain primarily with walking. Sitting is less painful. Imaging demonstrates a gr1 L4-5 Spondylolisthesis non-lytic with mod-severe degenerative facet findings. Three years prior, no listhesis present.
I was asked, what causes this?
It took a good sleep and strong coffee for the insights to come. The only way I see an aneterolisthesis to occur at that level is bone density lessening combined with flexion stressors. I am going to put money on osteopenia and suggesting a bone density test.
Anyone else with these thoughts?
Hi, I would say that he mechanism that can lead to spondylolysis is often linked to repetitive stress in extension rather than flexion. This type of stress is particularly common in certain sporting or physical activities like gymnastics, diving, tennis, and some forms of dance require movements that put the spine into repeated extension. These movements can place excessive pressure on the posterior part of the vertebra, particularly on the isthmus or pars interarticularis. Over time, this repeated pressure can lead to fatigue and a stress fracture in this area, resulting in spondylolysis. Another reason would be genetics. I agree with your idea of planning a bone density test. Knowing that a spondylolysis can be asymptomatic I would assess and treat the degenerative facet joints to make sure that the pain is not coming from there.
I was wondering about a non-lytic spondylolisthesis, in particular, an anterolisthesis
Hello, I took a second look, and now, at my error, did not notice the recent image taken in Nov 2023 ( no details on the image below ) was done weight bearing. This may explain the change. I have advised the pt. to seek out a bone density test based on her sex and age (Article Degenerative Spondylolisthesis Is Associated with Low Spinal...
) because I am suspicious non the less. Thank you for suggesting that I take another look closely.
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