Dawaa Reference

chronic

Spondylolysis / spondylolisthesis

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources3 sources

ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class LD66.01 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care · Spondylolysis - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK513333/

Verified against2 documents
  • No dose - referral pathway, no medicine given in primary care
  • Spondylolysis / spondylolisthesis - disease-level clinical article (spondylolysis-spondylolisthesis-clinical.txt)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (6)

  • Low back pain in the lumbar form or neck pain in the cervical form is a typical complaint [back pain · neck pain]
  • Pain tends to be intermittent and worsens with flexion and extension of the affected segment
  • Direct pressure over the affected area can bring the pain on
  • Nerve root compression produces sharp, shooting pain radiating down the leg [burning pain]
  • Lying flat can ease symptoms by reducing instability and taking pressure off neural structures
  • Buttock pain, leg numbness or weakness, and trouble walking accompany the radicular picture, with bowel or bladder dysfunction being rare [numbness]

Signs — what you find (4)

  • Inspection may show a step-off deformity or an exaggerated lumbar curve [visible deformity]
  • Extension of the lumbar spine tends to reproduce the pain on exam
  • Neurological testing can turn up motor, sensory, or reflex deficits matching a nerve root
  • A positive Stork test - standing on one leg with the spine extended - reproduces the lumbar pain and points to instability [back pain]

Tests (7)

  • Routine labs are not needed unless systemic features raise concern for infection or a metabolic cause
  • AP, lateral, and flexion-extension X-rays are first-line imaging, grading slippage by the Meyerding system
  • Meyerding grading runs from grade I at 1 to 25 percent slip through grade IV at 76 to 100 percent, with grade V or spondyloptosis over 100 percent
  • Oblique films can show a pars defect as the scotty dog sign, though they add radiation and their routine use is debated
  • MRI is preferred for assessing nerve elements, disc degeneration, and soft tissue, and picks up early stress reactions and marrow edema
  • SPECT imaging can find an early stress reaction or pars defect when plain films and CT are inconclusive
  • Spinopelvic parameters - pelvic incidence, sacral slope, and pelvic tilt - matter most in high-grade slips for surgical planning

If not this — what else fits (6)

  • Degenerative disc disease mimics it but usually lacks vertebral displacement on imaging
  • Disc herniation causes similar radicular symptoms but shows extrusion or protrusion rather than vertebral slippage
  • Spinal stenosis can overlap with claudication and root compression, but imaging shows canal narrowing rather than vertebral translation
  • Sacroiliac joint dysfunction can mimic the mechanical pain but lacks neurological deficits and has its own exam findings
  • In children, spina bifida occulta or congenital scoliosis can resemble it but without true vertebral displacement
  • Discitis or osteomyelitis should be suspected with systemic features like fever and elevated inflammatory markers, showing inflammatory change without slippage on imaging

SourceStatPearls "Spondylolisthesis" - disease-level clinical article

Presentation findings are traced to the source above.

1

NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE)

1st line
Adult dose and duration

A pars interarticularis defect (spondylolysis) or forward slip of a vertebra (spondylolisthesis) causing low back pain, common in adolescent athletes; mild cases are managed with analgesia and activity modification, with referral if the slip progresses or neurological symptoms appear. - Refer, with advice

Paediatric dose

Children follow the same pathway: recognise and refer. No primary-care medicine is implied.

Dose source

No dose - referral pathway, no medicine given in primary care

Why

A pars interarticularis defect (spondylolysis) or forward slip of a vertebra (spondylolisthesis) causing low back pain, common in adolescent athletes; mild cases are managed with analgesia and activity modification, with referral if the slip progresses or neurological symptoms appear.

Cautions
  • Cauda equina symptoms (saddle numbness, bladder or bowel dysfunction), progressive neurological deficit, high-grade vertebral slip.
  • No medicine is prescribed for this in primary care - this entry is for recognition and referral. Anything given is decided by the service it is referred to.
  • RED FLAG - Emergency red flag warning signs of cauda equina syndrome (bowel or bladder dysfunction, saddle anesthesia) requiring immediate surgical intervention are omitted

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.