In most cases, rather unspecific symptoms of spondylolisthesis are described. The clinical picture cannot usually be diagnosed on the basis of the examination findings alone. Only in the case of advanced juvenile spondylolisthesis can any changes in gait (tightrope walk, push gait) or the ski jump phenomenon be detected. With the ski jump phenomenon, a deformation of the lower lumbar spine similar to a ski jump is palpable and visible due to the sliding of the vertebrae. Imaging techniques help to diagnose the disease and its extent.
X-ray
In principle, X-ray imaging of the spinal column can be described as the basic diagnostic imaging technique for spondylolisthesis. The X-rays provide the treating physician with an insight into the spinal column posture. In addition, bony changes (calcium salt reduction, spinal curvature, a vertebral fracture, vertebral joint arthrosis (facet syndrome), vertebral body attachments, spondylolyses, spondylolistheses) and disc herniations can be detected.
Spondylolisthesis can be recognized on conventional x-rays in the lateral image. A common clinical classification of the severity of spondylolisthesis is the Meyerding classification. In the diagnosis, the sliding process is divided into 4 degrees of severity, depending on the quarter in which the extension of the rear edge of the sliding vertebra is located on the sliding surface of the vertebra below
- Meyerding I: up to 25% spondylolisthesis
- Meyerding II: up to 50% spondylolisthesis
- Meyerding III: up to 75% spondylolisthesis
- Meyerding IV: up to 100% spondylolisthesis (spondyloptosis)
Some spinal instability is not visible on normal lateral images, but is only noticeable in forward or backward bending of the trunk.
In these cases, so-called functional images of the spine help in bending the trunk forward and backward. The spondylolysis defect is best identified in diagnostics on oblique images of the lumbar spine as the “collar of the dog’s figure” or in a computer tomography (CT). Sectional imaging diagnostics (CT and MRI, either with or without contrast agent of the HWSLWS) allows the pain to be assigned to a specific nerve or a specific spinal segment.
With the help of a CT (computed tomography) examination of spondylolisthesis, more detailed questions regarding the bony structure in particular can be answered (e.g. spondylolysis (spondylolisthesis), spinal canal stenosis, vertebral body fracture). Even more valuable in spinal column diagnostics, however, is the MRI of the cervical/lumbar spine (magnetic resonance imaging), which, in addition to the bony structures, is significantly better than CT, and also shows the soft tissue structures (intervertebral discs, nerve roots, ligaments). All of the above-mentioned diseases can be detected by MRI and assigned to a specific spinal column section. Shown twice is the same X-ray image in which the typical configuration of a spondylolysis (dog figure) can be recognized.
