Materiały źródłowe

• #1 Spondylolisthesis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/sites/books/NBK430767/

  Spondylolisthesis is a spinal condition characterized by the displacement of one vertebra relative to the one below it, most commonly at the lumbosacral junction (L5-S1). […] Spondylolisthesis can arise from various causes, including congenital anomalies, degenerative changes, trauma, or systemic diseases, and is classified using the Wiltse classification system. […] Spondylolisthesis is driven by a combination of biomechanical stressors, degenerative changes, and congenital abnormalities that compromise spinal stability. […] In isthmic spondylolisthesis, the central initiating factor is a defect or fracture in the pars interarticularis, often caused by repetitive mechanical stress. […] Degenerative spondylolisthesis, in contrast, arises from the gradual deterioration of the spine’s support structures, particularly the intervertebral discs and facet joints.

• #1 Lumbosacral Spondylolisthesis: Practice Essentials, Background, Etiology

  https://emedicine.medscape.com/article/2179163-overview

  Spondylolisthesis is defined as forward translation of a vertebral body with respect to the vertebra below. […] Spondylolisthesis can occur at any level of the spinal column, although it is most common in the lower lumbar spine. Most cases are thought to result from minor overuse trauma, particularly repetitive hyperextension of the lumbar spine. […] Mechanical stresses play an important role in this process. Erect posture produces a constant downward and forward thrust on the lumbar vertebrae. Stresses on the pars interarticularis are accentuated during repetitive hyperextension, which results in increased contact of the caudal edge of the L4 inferior articular facet with the L5 pars interarticularis. This collective trauma may eventually result in a stress fracture of the pars interarticularis. Spondylolisthesis may occur when bilateral pars defects are present, which allows forward slippage of the vertebra (typically L5 on S1).

• #1 Spondylolisthesis – WikiSM (Sports Medicine Wiki)

  https://wikism.org/Spondylolisthesis

  Spondylolisthesis is defined as a displacement of one Vertebral Body relative to adjacent vertebrae. This most commonly occurs due to degenerative changes. Typically this occurs anteriorly, but can happen in any plane. […] There is no correlation between progression of clinical symptoms and progression of radiographic spondylolisthesis. In most patients, low grade spondylolisthesis rarely progresses and has a benign clinical course. Slip progression only occurs in about 30% of patients. […] Direction of slipping depends on several factors. Symmetry of facet joint lesions affects the direction of slippage. If facets are symmetrical, then slippage occurs in the sagittal plane. If facet joints are asymmetrical, then there is typically a rotary component.

• #1 Spondylolisthesis – Wikipedia

  https://en.wikipedia.org/wiki/Spondylolisthesis

  Spondylolisthesis is graded based upon the degree of slippage of one vertebral body relative to the subsequent adjacent vertebral body. […] Spondylolisthesis is classified as one of the six major etiologies: degenerative, traumatic, dysplastic, isthmic, pathologic, or post-surgical. […] Dysplastic anterolisthesis (also called type 1) results from congenital abnormalities of the upper sacral facets or inferior facets of the fifth lumbar vertebra, and accounts for 14% to 21% of all anterolisthesis. […] Isthmic anterolisthesis (also called type 2) is caused by a defect in the pars interarticularis (spondylolysis) but it can also be seen with an elongated pars. […] Degenerative anterolisthesis (also called type 3) is a disease of the older adult that develops as a result of facet arthritis and joint remodeling.

• #1 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Spondylolisthesis-Pathology.aspx

  There are five main types of spondylolisthesis that have distinct causes and associated pathologies. […] Dysplastic spondylolisthesis is a rare condition that tends to progress rapidly with severe symptoms presenting in a relatively short timeframe. […] The resulting weakness in the area can lead to movement and slipping of the spinal vertebrae, as well as the pathogenesis of spondylolisthesis. […] Pathologic spondylolisthesis is a rare type of spondylolisthesis that occurs due to damage to the posterior elements of the spine that may arise from a variety of causes. […] Although there are various causes for the vertebral slipping that is associated with spondylolisthesis, each of the types is associated with distinct symptoms as a result of the slipping of the vertebra.

• #1

  https://link.springer.com/article/10.1007/PL00003436

  The commonly accepted hypothesis set up by Brocher in 1950 that the dysplasia of the pars interarticularis vertebrae is an essential requirement for the occurrence of spondylolysis should be thought over in light of recent findings. […] Newly published investigations show that disturbed spinal growth leads to dysplasia of the vertebral arch and to spondylolysis. […] Disturbances that play an important role are biomechanical stress factors that result from the evolution from a quadripedal to a bipedal human locomotion as well as stress fractures of the vertebral pars interarticularis and defects in vertebral maturation in small infants. […] Neuere Untersuchungen machen deutlich, da die Wirbelbogendysplasie und die Spondylolyse als Folge eines gestrten Wirbelsulenwachstums entstehen. […] Als Strfaktoren werden die evolutionre Entwicklung vom Vierfler- zum Zweiflergang, Ermdungsfraktur der Interartikularportion und Wirbelreifungsstrung im Kleinkindesalter verantwortlich gemacht.

• #1 Pathophysiology of Spondylolisthesis.pptx

  https://www.slideshare.net/slideshow/pathophysiology-of-spondylolisthesis-pptx/273123417

  Spondylolisthesis refers to the anterior displacement(translation) of a vertebra with respect to the vertebra caudal to it. […] Spondylolysis refers to a defect in the pars interarticularis. […] The defect develops in 75% of the cases by 5 to 6 years of age. Of these, 75% present with spondylolisthesis. […] The mechanism inadequate sliding during extension of L4-5 and L5-S1 L5 pars is pinched – limited excursion of the two facet joints fatigue fracture -(Stress fracture) (nutcracker mechanism) in extension relatively low pelvic incidence and sacral slope. […] The hard cortical bone of the pars predisposes it to fatigue fracture, as well as nonunion. Even If healing occurs, the pars often heals in an elongated position. […] This pathoanatomy usually affects the L5 nerve root in patients with L5-S1 spondylolisthesis. slipping mechanically stretches the nerve over the sacrum, contributing to radiculopathy.

• #1 Isthmic Spondylolisthesis

  https://www.spine-health.com/conditions/spondylolisthesis/isthmic-spondylolisthesis

  Isthmic spondylolisthesis is a condition where a spinal vertebra slips forward on the one below it due to a structural defect in the small piece of bone, the pars interarticularis, which connects the two vertebrae on the back of the spine. […] The mechanism of isthmic spondylolisthesis revolves around the integrity of a small bony bridge in the back of the spine, called the pars interarticularis. This bridge is a thin piece of bone, which connects the upper and lower facet joints on the back of each vertebra. […] A broken pars interarticularis bone can compromise spinal stability. […] Research shows that the pars is subjected to the greatest force compared to any other structure in the lumbar spine, making it susceptible to stress fractures. […] In most cases, pars fractures are believed to be the result of repetitive motion. Other causes include trauma, or a congenital defect, weakening the structure of the pars bone.

• #1 Traumatic lumbar spondylolisthesis without facet fracture at L4/L5. A case report and literature review | Chinese Neurosurgical Journal | Full Text

  https://cnjournal.biomedcentral.com/articles/10.1186/s41016-016-0027-6

  L4-L5 traumatic spondylolisthesis has been rarely reported in the literature. […] The aim of the present paper is to report this rare lesion and discuss its mechanism and management. […] L4-L5 traumatic spondylolisthesis was caused by a high-energy mechanism and improper use of seat belt. […] The lumbar spine pure traumatic spondylolisthesis realizes traumatic bilateral lumbar facet locked syndrome. […] Traumatic spondylolisthesis at L4-L5 is associated with incorrect use of a three-point seat belt. […] The mechanism of injury seems to be forcible hyperextension. […] However, hyperflexion with varying degrees of distraction is the most frequent mechanism of facet dislocation in the lumbar spine. […] Therefore, in this case, we consider that, the mechanism of injury was a combination of hyperflexion, distraction, and rotation.

• #1 Spondylolysis and Isthmic Spondylolisthesis: A Guide to Diagnosis and Management | American Board of Family Medicine

  https://www.jabfm.org/content/35/6/1204.full

  Spondylolysis is the term used to describe an anatomic defect of the pars interarticularis, which typically results from stress reaction and subsequent fracture as a result of repetitive loading of the lumbar spine in extension and rotation. […] Consequently, spondylolysis and isthmic spondylolisthesis may be considered a continuum of the same disease process. […] Spondylolysis is best described as a fatigue fracture of the pars interarticularis from chronic, repetitive stresses placed on the lumbar spine. […] Several factors are thought to contribute to the development of spondylolysis and spondylolisthesis. A genetic component is a significant factor that has been implicated in the pathogenesis of this disease. […] The mechanical contribution of spondylolysis is best exemplified in athletes. High levels of physical activity have been strongly associated with this condition as the aforementioned forces are increased on the pars interarticularis during strenuous exercise. […] Once spondylolisthesis has occurred, the risk of further slippage is multifactorial. […] However, pronounced lumbosacral kyphosis and the presence of a high-grade spondylolisthesis on initial radiographic evaluation are the most predictive factors for further progression.

• #1 Spondylolisthesis | Published in Orthopedic Reviews

  https://orthopedicreviews.openmedicalpublishing.org/article/36917

  Spondylolisthesis is the anterior, lateral, or posterior translation of a superior vertebral segment over the adjacent inferior vertebra. Spondylolisthesis may progress from spondylolysis, which is the degeneration of the pars interarticularis. In fact, up to 70% of patients with bilateral pars defects progress to isthmic spondylolisthesis. This slippage most commonly occurs during periods of rapid growth. Disc slippage most often occurs at the L5-S1 joint. Severity of disc slippage is often quantified with the Meyerding grading system and is graded from I through V. High grade spondylolisthesis with greater than 50% disc slippage corresponds to Meyerding grade III or higher and presents with higher risk of neurological complications due to spinal cord and neural compression. High grade spondylolisthesis is most often due to isthmic rather than degenerative spondylolisthesis, as severe translation is enabled by pars interarticularis fracture.

• #1 Spondylolisthesis and the Treatment That Actually Works | Irvine Spine & Wellness Center

  https://chiropractor-irvine.com/what-is-spondylolisthesis/

  Spondylolisthesis is a condition in which a vertebral bone (bones in the spine) shifts anteriorly (forward) or posteriorly (backward) sometimes due to a fractured pars interarticularis of the vertebrae (part of the vertebra that keeps it connected to the ones above and below). […] Spondylolisthesis occurs when the pars interarticularis (labeled below) is fractured and there is a shift in the body of the vertebra. Spondylolisthesis is typically seen in the lumbar spine, specifically L4 and L5, but can occur anywhere in the spine. […] The majority of spondylolisthesis cases have a hereditary component. A genetic weakness of the pars interarticularis is the main contributing factor and can be referred to as congenital spondylolisthesis. […] Isthmic spondylolisthesis is a case in which spondylosis occurs first. The fracture or fractures are so damaging that a shift of the vertebrae is the end result.

• #1

  https://journals.lww.com/spinejournal/abstract/1990/11010/natural_history_of_degenerative_spondylolisthesis_.21.aspx

  To clarify the natural course of degenerative spondylolisthesis, the mechanism and progression of disk slippage were studied clinically and radiographically in 40 patients. […] General joint laxity was observed in many patients (65%), and this was believed to be involved in the pathogenic mechanism of this disease. […] These findings suggest that careful consideration of the natural mechanisms of spinal restabilization as well as the natural course of the disease is important.

• #2 Spondylolisthesis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/sites/books/NBK430767/

  Dysplastic spondylolisthesis occurs when congenital malformations of the lumbosacral spine, eg, underdeveloped facets or a dysplastic sacrum, increase susceptibility to vertebral slippage. […] Muscles and ligaments also significantly influence spondylolisthesis pathophysiology. […] Additionally, spondylolisthesis often narrows the neural foramen and central canal, potentially compressing nerve roots. […] The pelvic parameters, including pelvic incidence, sacral slope, and pelvic tilt, affect the spinal biomechanics associated with spondylolisthesis. […] In summary, spondylolisthesis arises from a multifaceted interplay of mechanical, degenerative, and sometimes congenital factors that erode the structural and functional integrity of the spinal column.

• #2 Isthmic Spondylolisthesis

  https://www.spine-health.com/conditions/spondylolisthesis/isthmic-spondylolisthesis

  The fracture of the pars interarticularis is known as a spondylolysis. […] Over time, spondylolysis can progress, leading to the slip of one vertebra over the other called spondylolisthesis. This slip always occurs in a forward direction and disrupts the normal alignment of the spine, causing instability and abnormal movement between the affected vertebrae. […] Isthmic spondylolisthesis can also lead to degenerative changes in the affected spinal segment. The slipped vertebra increases the stress within the affected segment, leading to abnormal motion between the vertebrae. This abnormal motion can accelerate wear and tear on the intervertebral discs, facet joints, and surrounding structures. […] As a compensatory mechanism, the body may initiate the growth of abnormal bone, called bone spurs or osteophytes, further impacting the structural integrity of the spinal segment.

• #2 Section 15 Chapter 1: Degenerative Spondylolisthesis – Pathogenesis, Natural History and Classifications : Wheeless’ Textbook of Orthopaedics

  https://www.wheelessonline.com/issls/section-15-chapter-1-degenerative-spondylolisthesis-pathogenesis-natural-history-and-classifications/

  Facet tropism with sagittal orientation of the facets, for example, has long been considered a causative factor in the development of degenerative spondylolisthesis. […] The segment most commonly affected by degenerative spondylolisthesis is L4-L5, and in 66% of the patients there is only single level involvement. […] The L4-5 level is affected 69 times more often than the other lumbar levels, which is suggested to be caused by the strong ilio-lumbar ligaments which aim to keep L5 in its anatomical position. […] The high pedicle-facet angle seen at the L4-L5 level may also contribute, causing the L4 vertebra to be more likely to slip forward than any other lumbar vertebrae. […] Degenerative spondylolisthesis at L4-L5 level has also been demonstrated to occur more frequently in individuals with more coronal orientation of the L5-S1 facets and further occur more often in individuals with a sacralization of this segment.

• #2 Spondylolisthesis: Causes, Symptoms & Treatment | 2025

  https://orthofixar.com/spine/spondylolisthesis-causes-symptoms-treatment/

  Dysfunction of the inter-vertebral disc: The inter-vertebral disc at the level of the spondylolisthesis is subjected to considerable anteriorly directed shear forces and is the main structure that opposes these shear forces, functioning to prevent against further slippage and keeping the spinal motion segment in a stable equilibrium. It is postulated that slip progression after skeletal maturity is almost always related to inter-vertebral disc degeneration at the slip level. As the biochemical integrity of the inter-vertebral disc is lost, the lumbosacral slip becomes unstable and progresses. […] Other factors such as the lumbosacral angle, ligamentous laxity, previous pregnancy, and hormonal factors impose an increased stress on the L45 facet joints, and, as most of the stress is placed anteriorly on the inferior facet of L4, the wear pattern is concentrated at this point, creating a more sagittally orientated joint by way of remodeling.

• #2 Spondylolisthesis – Wikipedia

  https://en.wikipedia.org/wiki/Spondylolisthesis

  Traumatic anterolisthesis (also called type 4) is rare and results from acute fractures in the neural arch or facet joint structure, other than the pars. […] Pathologic anterolisthesis (also called type 5) is caused by either infection or a malignancy. […] Post-surgical/iatrogenic anterolisthesis (also called type 6) is caused by complications after surgery. […] If the spondylolisthesis is mobile or increases its position with movements such as bending forwards (flexion) or backwards (extension), it’s called 'unstable’. […] Instability, or a lot of movement in the spine, is considered significant if there’s more than 4 mm of movement (translation) or more than a 10 change in the angle of the spine when moving.

• #2 Spondylolisthesis, Spondylolysis, and Spondylosis: Practice Essentials, Anatomy, Pathophysiology

  https://emedicine.medscape.com/article/1266860-overview

  Spondylolisthesis may or may not be associated with gross instability of the spine. Some individuals remain asymptomatic even with high-grade slips, but most complain of some discomfort. […] Degenerative lumbar spondylolisthesis is one of the most common causes of low back pain and, as such, was an area of heightened research during the 20th century. […] The pars interarticularis may be congenitally defective (eg, in the spondylolytic subtype of isthmic spondylolisthesis) or undergo repeated stress under hyperextension and rotation, resulting in microfractures. […] If a fibrous nonunion forms from ongoing insult, elongation of the pars and progressive listhesis results. […] Biomechanical factors are significant in the development of spondylolysis leading to spondylolisthesis. […] In degenerative spondylolisthesis, intersegmental instability is present as a result of degenerative disk disease and facet arthropathy. […] The slip occurs from progressive spondylosis within this three-joint motion complex. […] Pathologic spondylolisthesis results from generalized bone disease, which causes abnormal mineralization, remodeling, and attenuation of the posterior elements leading to the slip.

• #2 Spondylolisthesis | Published in Orthopedic Reviews

  https://orthopedicreviews.openmedicalpublishing.org/article/36917

  Degenerative spondylolisthesis is considered a disease of aging with a predilection for females, hypothetically due to both the increased laxity in female ligaments as well as other hormonal factors. Most cases of degenerative spondylolisthesis are low grade and classified as either Meyerding grade I or II. Low back and lower extremity pain may be observed due to focal disc slippage and degeneration as well as nerve impingement and ensuing spinal stenosis. […] There exist numerous other etiologies of spondylolisthesis in addition to the isthmic and degenerative subtypes. A rarer etiology of spondylolisthesis includes dysplastic (i.e. congenital) spondylolisthesis, and is due to a congenital anomaly of the pars interarticularis which subsequently results in early anterior disc translocation, most commonly at L5-S1. Early disc slippage can also result in spondylolysis due to increased stress on the pars interarticularis. Congenital disease is often multifactorial and made worse by repetitive movements of the lower back. Traumatic spondylolisthesis is caused by trauma that fractures a part of the posterior column of the spine besides the pars, and usually coexists with other injuries. Pathologic spondylolisthesis is similar to traumatic, but is however due to infection, neoplasm, autoimmunity, or another pathology unrelated to trauma. Iatrogenic spondylolisthesis can cause all of the aforementioned variants of the disease, and usually occurs following a large spinal decompression (laminectomy). This procedure can cause destabilization of the vertebrae, with subsequent disc slippage.

• #2 Degenerative Spondylolisthesis

  https://www.spine-health.com/conditions/spondylolisthesis/degenerative-spondylolisthesis

  Degenerative spondylolisthesis causes pain through one or more of the following processes: degeneration of facet joints causes inflammation of the cartilaginous facet joint lining, tension within the capsule and ligaments that surround the facet joints as the vertebra slips, spasm of the muscles that support the affected spinal segment, and narrowing of the central canal (spinal stenosis) and/or intervertebral foramen (foraminal stenosis) causing compression of the neural elements. […] The degree of degenerative spondylolisthesis may increase over time. […] The body naturally employs several mechanisms to protect against further slippage, including formation of bone spurs, hardening of bone, and deposition of calcium in the ligaments.

• #2 Spondylolisthesis: A Historical Perspective on Etiology, Diagnosis, and Treatment | Musculoskeletal Key

  https://musculoskeletalkey.com/spondylolisthesis-a-historical-perspective-on-etiology-diagnosis-and-treatment/

  The iliolumbar ligaments can provide checkreins to excessive anterior displacement by the vertebral body, while the bony buttress from the proliferation of bone on the anterior surface of the sacrum can also stop the slippage progression of the L5 vertebra. […] In 1957, Wiltse theorized that the pars lesion may result from congenital weakness. […] In 1959, Nathan, after inspecting 450 skeletons, ascribed the condition of spondylolysis and its resultant spondylolisthesis to the pincer effect, and that the presence of preceding bone abnormalities or congenital defects of the pars interarticularis would seem unnecessary for the production of the pars defect. […] Continuous compressive effect of these two articular processes on the pars interarticularis can ultimately cause a fracture of the pars.

• #3 Spondylolisthesis: A Historical Perspective on Etiology, Diagnosis, and Treatment | Musculoskeletal Key

  https://musculoskeletalkey.com/spondylolisthesis-a-historical-perspective-on-etiology-diagnosis-and-treatment/

  Nathan also explained why spondylolysis commonly occurred at the fifth lumbar and sacrum junction. […] In 1976, Wiltse et al. described one of the more useful classifications of spondylolysis and spondylolisthesis that is commonly used today. […] The classification distinguishes the multifactorial factors causing these conditions. […] Type 1 is due to the dysplastic predisposition of the bony architecture of the vertebrae. […] Type 2, called isthmic spondylolisthesis, is the most frequent and more commonly involves L5 and S1, is associated with a defect in the pars interarticularis. […] This defect can be due to chronic stress fracture, an elongated but intact pars due to chronic stress, or acute pars fracture. […] Type 3 is secondary to the degenerative process and is commonly found at L4 and L5. […] Chronic degenerative changes in the discoligamentous complex lead to intersegmental instability of the facet joints and disc space.

• #3 Section 15 Chapter 1: Degenerative Spondylolisthesis – Pathogenesis, Natural History and Classifications : Wheeless’ Textbook of Orthopaedics

  https://www.wheelessonline.com/issls/section-15-chapter-1-degenerative-spondylolisthesis-pathogenesis-natural-history-and-classifications/

  Individuals with higher pelvic incidence and greater lumbar lordosis have been reported to have a greater stress in the lower lumbar spine, which may explain the higher incidence of degenerative spondylolisthesis noted in this subset of patients. […] As a consequence of the listhesis with a parallel translation of the disc and also often with narrowing of the disc space, secondary changes such as spur formation, subchondral sclerosis, hypertrophic facet arthrosis, hypertrophy and ossification of ligaments are seen in varying degrees in these patients. […] These changes, in particular the bone formations in various locations, provide a natural attempt to re-stabilize the motion segment. […] Thus, in advanced stages of degeneration the affected spinal segment shows significantly less mobility than the adjacent segments.

• #3 Pathophysiology of Spondylolisthesis.pptx

  https://www.slideshare.net/slideshow/pathophysiology-of-spondylolisthesis-pptx/273123417

  As pelvic incidence increases, sacral slope increases and lumbar lordosis increases to maintain sagittal balance. patients with spondylolisthesis have a greater pelvic incidence than controls increased pelvic incidence – predispose to spondylolisthesis. […] slip percentage, Meyerding grade, and slip angle have been shown to be predictive of progression.

• #4 Section 15 Chapter 1: Degenerative Spondylolisthesis – Pathogenesis, Natural History and Classifications : Wheeless’ Textbook of Orthopaedics

  https://www.wheelessonline.com/issls/section-15-chapter-1-degenerative-spondylolisthesis-pathogenesis-natural-history-and-classifications/

  Disc degeneration also produces segmental instability in the coronal plane. […] This may lead to lateral listhesis with lateral wedging and angulation of the vertebral body, secondary to asymmetric degeneration of the facet joints. […] This is the cause of degenerative scoliosis which is encountered relatively frequently in patients with degenerative spondylolisthesis.

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