IS Case 568: Spondylolysis with spondylolisthesis of the lumbar spine

Sirisha Jasti, MD

Imaging Sciences URMC

Imaging Sciences URMC 2010
Publication Date: 2011-11-16


Patient is a 15-year-old male with lower back pain.


Lateral view of the lumbar spine showed spondylolysis at L5 with spondylolisthesis of L5 over S1.


Spondylolysis is a defect in the pars interarticularis. It is commonly caused due to repeated trauma resulting in a fracture of the pars interarticularis. Spondylolysis occurs more frequently at L5. Spondylolisthesis occurs when the pars interarticularis is fractured on both sides resulting in slippage of one vertebral body over the other.

Spondylolisthesis is graded based on the degree of slippage of the vertebral body relative to the vertebral body width.

Grade I: slippage of less than 25%

Grade II: slippage between 25 and 50%

Grade III: slippage between 50 and 75%

Grade IV: slippage between 75 and 100%

The main treatment for spondylolysis with spondylolisthesis is conservative management of symptoms with serial follow-up imaging. Surgical fusion of the vertebrae is considered in cases of high grade slippage or neurologic abnormalities.


  1. Garry JP, McShane J. Lumbar spondylolysis in adolescent athletes. J Fam Pract. 1998 Aug;47(2):145-9. PMID: 9722803

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