Degenerative spondylolisthesis I: general principles

Lumbar degenerative spondylolisthesis is the result of the progression from degenerative changes in the intervertebral disc and facet joints that lead to destabilizing one or more vertebral segments. It is characterized by the anterior sliding of the vertebral body secondary to the sagittalization of the facet joints. Wiltse, Newman, and Macnab classified it as type III. It is a pathology typical of elderly patients that predominate in women with a ratio of 5:1 compared to men; the most affected segment is L4-L5, the listhesis rarely exceeds 30% slip. It may or may not generate clinical manifestations, and the severity of these does not always correlate with the degree of sliding. The cardinal symptom is lumbar pain with or without radicular pain. Neurogenic claudication occurs in 75% of patients; it is caused by blood hypoperfusion secondary to the compression of the nerve roots, manifesting as pain in the lower limbs with variable walking distances. For the diagnosis of degenerative spondylolisthesis, comprehensive evaluation with static, dynamic radiographic studies in a standing position and magnetic resonance imaging are essential. The conservative treatment is the first-line therapy; it includes analgesics, anti-inflammatories, physiotherapy.