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Spondylolysis/spondylolisthesis is a topic covered in the 5-Minute Emergency Consult.

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  • Spondylolysis:
    • Bony defect at the pars interarticularis (the isthmus of bone between the superior and inferior facets)
    • Can be unilateral or bilateral
    • Bilateral form has a much higher likelihood of slippage or spondylolisthesis than the unilateral form.
  • Spondylolisthesis:
    • The slipping forward of 1 vertebra upon another
    • Spondylolysis can contribute to spondylolisthesis, which is noted in ∼5% of the population. It is 2–4 times more common in males.
    • Of those with spondylolysis, 50% will have some degree of spondylolisthesis develop during their lifetime, and 50% of those will be symptomatic:
    • Literature does not associate athletic activity with increased slippage.
    • Spondylolisthesis predisposes to nerve root impingement and frequently sciatica.
  • Classification:
    • Type 1—dysplastic: Congenital defect of the neural arch or intra-articular facets is often associated with spina bifida occulta
    • Type 2—isthmic: Stress fracture from repetitive microtrauma through the neural arch
    • Type 3—degenerative: Long-standing segmental instability
    • Type 4—traumatic
    • Type 5—pathologic: Generalized or focal bone disease
    • Spondylolisthesis is divided into 4 grades based on degree of slippage (Meyerding grading system):
      • Grade I: Up to 25% of the vertebral body width
      • Grade II: 26–50% of vertebral body width
      • Grade III: 51–75% of vertebral body width
      • Grade IV: 76–100% of vertebral body width
    • The most common location for spondylolisthesis is L5 displaced on the sacrum (85–95%), followed by L4 on L5.

Pediatric Considerations
  • Spondylolysis is one of the most common causes of serious low back pain in children, although it is most often asymptomatic.
  • Symptoms most often present during adolescent growth spurt from age 10–15 yr.
  • Seen commonly in athletic teens; particularly in sports involving back hyperextension (e.g., gymnastics, diving, football).
  • Acute symptoms are related to trauma.


Unknown; theories include congenital pars anomalies, alterations in bone density, and recurrent subclinical stress injury.

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Rosen, Peter, et al., editors. "Spondylolysis/spondylolisthesis." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307659/all/Spondylolysis_spondylolisthesis.
Spondylolysis/spondylolisthesis. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307659/all/Spondylolysis_spondylolisthesis. Accessed April 23, 2019.
Spondylolysis/spondylolisthesis. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307659/all/Spondylolysis_spondylolisthesis
Spondylolysis/spondylolisthesis [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 23]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307659/all/Spondylolysis_spondylolisthesis.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Spondylolysis/spondylolisthesis ID - 307659 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307659/all/Spondylolysis_spondylolisthesis PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -