# Spondylolysis / spondylolisthesis - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - 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 date: 2026-08 ## Verified against - No dose - referral pathway, no medicine given in primary care - Spondylolysis / spondylolisthesis - disease-level clinical article (spondylolysis-spondylolisthesis-clinical.txt) ## Treatment metadata - No drug therapy in primary care (Referral & Advice) ## Complete treatment card ```text SPONDYLOLYSIS / SPONDYLOLISTHESIS 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/ Review status: REVIEWED against No dose - referral pathway, no medicine given in primary care, Spondylolysis / spondylolisthesis - disease-level clinical article (spondylolysis-spondylolisthesis-clinical.txt) (2026-08) 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 Source StatPearls "Spondylolisthesis" - disease-level clinical article Status traced to the source above 1. NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE) [1st line] Adult 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 Peds Children follow the same pathway: recognise and refer. No primary-care medicine is implied. 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. Caution 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. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)