What is Spondylolistheisis?
Spondylolistheisis refers to the slipping of one vertebra forward on another. It is often associated with bilateral pars defects that usually develop in early childhood and have a definite family predisposition. Pars defects that develop due to athletic activity (stress fractures) rarely result in spondylolisthesis. Spondylolisthesis is most commonly seen in children between the ages of 9 and 14. In the vast majority of cases it is the L5 vertebra that slips forward on the S1.

Classification
The spondylolisthesis is graded according to the degree of slip of the vertebra. A grade I slip denotes that a vertebra has slipped 25% over the body of the vertebra underlying it; in a grade II slip the displacement is 25%; in a grade III slip, 50%; and in a grade IV slip; greater than 75%.

Grade I spondylolisthesis is often symptomatic and the patients may be unaware of the defect. Patients with grade II or higher slips may complain of low back pain, with or without leg pain. The back pain is aggravated by extension activities.

Treatment
Treatment of patients with grade I or grade II symptomatic spondylolisthesis involves rest from aggravating activities combined with abdominal and extensor stabilizing exercises and hamstring stretching. If there is stiffness of the joints above or below the slip on clinical assessment, these joints should be mobilized.

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