Introduction

• Spondylolisthesis refers to slipping of part or all of one vertebra forward on another.
• Usually associates with bilateral pars defects
• Most common in children (9-14yr of age)
• Familial predisposition. Athletes overuse injury (stress fracture) rarely progress to Spondylolisthesis
• Usually L5 slips forward on S1

Staging

• Grade 1 (<25% slip)
• Grade 2 (25 - 50% slip)
• Grade 3 (50 - 75% slip) 
• Grade 4 (>75% slip)

Diagnosis

• Present with low back pain +/_ lower leg pain
• A gap may be palpable on examination
• Lateral Xray show the slip

Management for Grade 1 and 2 slip

• Symptomatic approach
• Rest from aggravating factors
• Strengthening of abdominal and extensor + stretching Hamstring
• Manipulation and mobilisation of stiff joints above and below (should not manipulate at the level of slip)
• Can return to sports when pain free on lumber extension and 

Management for grade 3 and 4 slip

• Symptomatic management
• Should avoid contact sports and high speed sports
• If slip progress, can consider Spinal Fusion