Radiology Corner – Pseudo or Degenerative Spondylolisthesis

By: Terry R. Yochum, DC, DACBR, Fellow, ACCR and Chad J. Maola, DC

Figure 1. Cervical Degenerative Spondylolisthesis. There is a degenerative anterolisthesis of C7 upon T1, which has occurred as a result of extensive facet arthrosis. Multilevel discogenic spondylosis is seen at the C3-C7 levels. The degenerative vacuum phenomenon is seen in the anterior corners of the disc spaces between C4/5 and C5/6.

Figure 1. Cervical Degenerative Spondylolisthesis. There is a degenerative anterolisthesis of C7 upon T1, which has occurred as a result of extensive facet arthrosis. Multilevel discogenic spondylosis is seen at the C3-C7 levels. The degenerative vacuum phenomenon is seen in the anterior corners of the disc spaces between C4/5 and C5/6.

DISCUSSION

Degenerative spondylolisthesis is a type of non-spondylolytic spondylolisthesis (no pars defects). Degenerative spondylolisthesis can affect any degenerated vertebral segment positioned within a lordotic curve. In the lumbar spine, it most commonly affects L4 (Figs. 2 & 3), with approximately 10 times more prevalence than at the L3 or L5 vertebrae.

 

 

Figure 2. Degenerative Spondylolisthesis of L4. Observe the degenerative spondylolisthesis of L4 upon L5 associated with discogenic narrowing of the disc space, coupled with posterior facet arthrosis.

Figure 2. Degenerative Spondylolisthesis of L4. Observe the degenerative spondylolisthesis of L4 upon L5 associated with discogenic narrowing of the disc space, coupled with posterior facet arthrosis.

Figure 3. Specimen Radiograph L3/4. Observe the pathological specimen with extensive degeneration at the L3/4 level allowing degenerative anterolisthesis of L4. (Courtesy of Donald Resnick, MD). Generally anterior displacement of the L4 vertebral body is not greater than 25%. The majority of the cases involve only 10-15% displacement.

Figure 3. Specimen Radiograph L3/4. Observe the pathological specimen with extensive degeneration at the L3/4 level allowing degenerative anterolisthesis of L4. (Courtesy of Donald Resnick, MD). Generally anterior displacement of the L4 vertebral body is not greater than 25%. The majority of the cases involve only 10-15% displacement.

Within the cervical lordosis, degenerative spondylolisthesis commonly affects the C7 and T1 vertebra, but any level within the curve may be affected.

The distribution of degenerative spondylolisthesis varies among populations. It is six times more common in females 60 years of age or older and in males of the same age. It is rare in individuals under 50 years of age. Degenerative spondylolisthesis is three times more common in blacks than whites. There are no adequate explanations for these sexual and racial disparities. Degenerative spondylolisthesis is four times more likely to be found in association with a sacralized L5 vertebra.

The 3 F’s of degenerative spondylolisthesis are:

Female

Fourth lumbar vertebra

Forty years or older

Pain associated with degenerative spondylolisthesis is usually secondary to arthritic changes and foraminal compromise. Degenerative facet arthropathy causing lateral recess stenosis and neurologic signs and symptoms is possible. Degenerative spondylolistheses should be suspected in any patient presenting with symptoms of intermittent neurogenic claudication.

References

1. Yochum TR, Rowe LJ. Essentials of Skeletal Radiology, 3rd ed. Baltimore: Williams & Wilkins, 2004:1190.

2. Rosenberg MJ. Degenerative spondylolisthesis. Clin Orthop 1976; 117:112.