The PowerPoint presentation on Physiotherapy Management of Spondylolisthesis has been successfully completed. This informative session explored the crucial role of physiotherapy in effectively managing spondylolisthesis, restoring spinal stability, and optimizing functional outcomes for patients. The presentation covered various aspects of spondylolisthesis, including its definition, classification, common causes, and risk factors. Attendees gained insights into the clinical manifestations of the condition and the resulting limitations in daily activities. The role of physiotherapy in the comprehensive management of spondylolisthesis was emphasized, highlighting the importance of collaboration between physiotherapists and healthcare professionals. The presentation discussed the comprehensive assessment techniques employed by physiotherapists to evaluate patients accurately. Attendees learned about the goals of physiotherapy interventions, which included reducing pain and inflammation, restoring spinal stability, improving mobility and flexibility, and enhancing overall function. Evidence-based physiotherapy interventions such as therapeutic exercises, manual therapy techniques, postural education, and ergonomic modifications were showcased, providing practical knowledge for managing spondylolisthesis. Overall, the completed PowerPoint presentation provided a comprehensive understanding of the vital role physiotherapy plays in the management of spondylolisthesis. Attendees were equipped with practical knowledge and evidence-based strategies to effectively restore stability, alleviate pain, and optimize functional outcomes for patients with this condition. The completed PowerPoint presentation on Physiotherapy Management of Spondylolisthesis has successfully highlighted the power of physiotherapy in transforming the lives of individuals with spondylolisthesis.

1. PHYSIOTHERAPY
MANAGEMENT OF
SPONDYLOLISTHESIS
BY
SOCHIMA JOHNMARK OBIEKWE
SPT, Nnamdi Azikiwe University.
AT
Federal Medical Center Asaba, Nigeria.

2. OUTLINE
 Introduction
 Epidemiology
 Etiology
 Classifications
 Clinical presentations
 Assessment
 Management and Outcome measures
 Conclusion
 References

3. INTRODUCTION
•Spondylolisthesis is the slippage of one vertebral body
with respect to the adjacent vertebral body causing
mechanical or radicular symptoms or pain.
•It is commonly preceded by spondylosis.
•It can be due to:
•Congenital.
•Acquired.
•Idiopathic Causes[1]

4. INTRODUCTION CONT’D
• Spondylolisthesis commonly occurs on the lumbar spine, and also on the
cervical spine, but rarely in most cases of trauma, it occurs on the thoracic
spine.
• It occurs due to a crack or stress fracture of the pars interarticularis (the
weakest portion of the vertebra).
• The interarticularis separate the injured vertebra to shift or slip forward on the
vertebra directly below it.
• 2 directions- most commonly in anterior translation, called anterolisthesis, or
a backward translation, called retrolisthesis.[2]

6. EPIDEMIOLOGY
• Commonly occurs at the L5-S1 level, then L4-L5.
• Degenerative spondylolisthesis: more common in adult females than males
with increased risk in the obese.
• Isthmic spondylolisthesis: common in the adolescent but may go
unrecognized until symptoms develop in adulthood. It is prevalent in males.[3]
• Dysplastic spondylolisthesis: common in the pediatric population, with
females more.[4]
• Grade I spondylolisthesis accounts for 75% of all cases.[3]

7. ETIOLOGY
• Repetitive stress or overuse
• Genetics[5]
• Decreased strength of the neural arch at a young age
• Traumatic injuries
• Laminectomy-triggered
• Microtrauma in sports
• Pathological causes - Neoplasm, connective tissue disease, etc.

8. RISK FACTORS
• Advanced age (after 50 yo), female gender and greater facet joint
angle according to John et al,. [18]
• Higher Body Mass Index (BMI)
• Lower Bone Mineral Density (BMD)
• Degenerative Arthritis.

9. CLASSIFICATIONS:
WILTSE CLASSIFICATION [17]
• Type I: Dysplastic spondylolisthesis (congenital)
• Type II: Isthmic spondylolisthesis
• Type III: Degenerative spondylolisthesis
• Type IV: Traumatic spondylolisthesis
• Type V: Pathologic spondylolisthesis
• Type VI: Iatrogenic spondylolisthesis

10. GRADES OF SPONDYLOLISTHESIS:
MYERDING CLASSIFICATION
• Grade 1: <25% slippage (most common)
• Grade 2: 26-50% slippage
• Grade 3: 51-75% slippage
• Grade 4: 76-100% slippage
• Grade 5: over 100% slippage. Also called
SPONDYLOPTOSIS.

11. X-RAY PRESENTATION OF GRADE 1
AND GRADE 2 LUMBAR
SPONDYLOLISTHESIS [16]

12. MRI PRESENTATION OF GRADE 3 AND
GRADE 4 LUMBAR
SPONDYLOLISTHESIS[16]

13. CLINICAL PRESENTATIONS
• Patients typically have low back pain.
• Pain is exacerbated by extending at the affected segment.
• Pain decreases as the patient assumes flexed posture.
• Pain may be exacerbated by direct digital palpation of the affected
segment.
• lumbosacral kyphosis, compensatory lordosis of the proximal
spine may occur.

14. CLINICAL PRESENTATIONS CONT’D
• The patient often develops a crouched Gait. [7]
• Atrophy and muscle weakness of low back.
• Tense hamstrings, hamstrings spasms
• Disturbances in coordination and balance, difficulty walking
• Rarely loss of bowel or bladder Control.[1]

15. A PICTORIAL REPRESENTATION OF CROUCH GAIT

16. DIAGNOSIS
• PHYSICAL EXAMINATION:
• General physiotherapy assessment.
• Step-off sign palpated at the lumbosacral area.
• Painful straight leg raising.
• Flattened lumbar lordosis
• Limitation of lumbar range of motion
• Pain on the affected side with single-limb standing lumbar extension
• Hamstring tightness

17. STEP-OFF SIGN [12]

18. DIAGNOSIS CONT’D
•RADIOLOGICAL EXAMINATIONS:
•X-ray: Anteroposterior and lateral plain films.
•Computed tomography (CT) of the spine at the sagittal
reconstruction.
•MRI of the spine

19. DIFFERENTIAL DIAGNOSIS
1.Spondylolysis [8] [9]
2.Metastatic spine disease [10]
3.Low back pain [11]
4.Osteoarthritis [11]
5.Neuroforaminal stenosis [11]
6.Spinal Stenosis [11]

20. X-RAY REPRESENTATION OF SPONDYLOLISTHESIS[15]

21. MRI REPRESENTATION OF SPONDYLOLISTHESIS [15]

22. TREATMENT: MEDICAL (CONSERVATIVE)
AND SURGICAL MANAGEMENT
• Resting and avoiding movements like lifting, bending, and sports.[10]
• Analgesics and NSAIDs: musculoskeletal pain and anti-inflammatory effect-
nerve root and joint irritation.
• Epidural steroid injections to relieve low back pain and lower extremity.[13]
• A brace may be used.[14]
• Surgical management comes in when conservative management fails.

23. PHYSIOTHERAPY MANAGEMENTS
AIMS
• Pain Relief.
• Spinal Stability and Alignment.
• Functional Improvement and mobility to improve daily activities and overall
QOL.
• Maintain physiological properties of the core muscles and surrounding
muscles
• Postural correction and patient education.
• Gait training.

24. PHYSIOTHERAPY MANAGEMENTS CONT’D
• MEANS:
• Pain relief modalities such as IRR, TENS, Massage using Analgesic creams.
• Spinal Traction and
• Assistive devices or orthotics, such as braces or supports, to provide
additional spinal stability
• Use of exercises (isotonic or metric) to improve muscle balance, stretching,
strength. Balance, endurance, and cardio fitness training.

25. PHYSIOTHERAPY MANAGEMENTS CONT’D
• Positioning and postural education in sitting lying etc.
• Gait training
• Educate on:
• Condition
• lifestyle modifications,
• Activity modifications, and
• Strategies for self-management and prevention.

26. WILLIAMS FLEXION EXERCISES:
• Pelvic Tilts
• Partial sit-ups
• Knee-to-chest
• Hamstring stretch
• Standing lunges
• Seated trunk flexion
• Full squat

28. OUTCOME MEASURES
• Disability: oswestry disability index, the quebec back pain disability scale
• Dysfunctional thoughts: short form of the medical outcomes study (SF-36)
• Pain: pain numerical rating scale.
• Quality of life: WHOQOL

29. REFERENCES
1. Tenny S, Gillis CC. Spondylolisthesis. InStatPearls [Internet] 2019 Mar 27. StatPearls Publishing. Available
from:https://www.ncbi.nlm.nih.gov/books/NBK430767/ (last accessed 26.1.2020
2. Iguchi T, Wakami T, Kurihara A, Kasahara K, Yoshiya S, Nishida K. Lumbar multilevel degenerative
spondylolisthesis: radiological evaluation and factors related to anterolisthesis and retrolisthesis. Clinical Spine Surgery.
2002 Apr 1;15(2):93-9.
3. Tenny S, Gillis CC. Spondylolisthesis. [Updated 2022 May 24]. In: StatPearls [Internet]. Treasure Island (FL):
StatPearls Publishing; 2023 Jan-.
4. https://emedicine.medscape.com/article/310235-overview#a1
5. https://orthoinfo.aaos.org/en/diseases--conditions/spondylolysis-and-spondylolisthesis
6. Wicker A. Spondylolysis and spondylolisthesis in sports: FIMS Position Statement. International SportMed
Journal. 2008 Jan 1;9(2):74-8.
7. Mataliotakis GI, Tsirikos AI. Spondylolysis and spondylolisthesis in children and adolescents: current concepts
and treatment. Orthopaedics and Trauma. 2017 Dec 1;31(6):395-401.

30. REFERENCES
8. Tsirikos AI, Garrido EG. Spondylolysis and spondylolisthesis in children and
adolescents. The Journal of bone and joint surgery. British volume. 2010 Jun;92(6):751-9.
9. Thein-Nissenbaum J, Boissonnault WG. Differential diagnosis of spondylolysis in a patient
with chronic low back pain. Journal of Orthopaedic & Sports Physical Therapy. 2005
May;35(5):319-26.
10. Kalichman L, Kim DH, Li L, Guermazi A, Berkin V, Hunter DJ. Spondylolysis and
spondylolisthesis: prevalence and association with low back pain in the adult community-based
population. Spine. 2009 Jan 15;34(2):199.
11. Metzger R, Chaney S. Spondylolysis and spondylolisthesis: What the primary care provider
should know. Journal of the American Association of Nurse Practitioners. 2014 Jan;26(1):5-12.
12. Step-off-sign. Physiopedia. https://www.physio-pedia.com/Spondylolisthesis#cite_ref-18

31. REFERENCES
13. Weinstein JN, Lurie JD, Tosteson TD, Hanscom B, Tosteson AN, Blood EA, Birkmeyer NJ,
Hilibrand AS, Herkowitz H, Cammisa FP, Albert TJ. Surgical versus nonsurgical treatment for
lumbar degenerative spondylolisthesis. New England Journal of Medicine. 2007 May
31;356(22):2257-70.
14. Funao H, Tsuji T, Hosogane N, Watanabe K, Ishii K, Nakamura M, Chiba K, Toyama Y,
Matsumoto M. Comparative study of spinopelvic sagittal alignment between patients with and
without degenerative spondylolisthesis. European Spine Journal. 2012 Nov;21(11):2181-7.
15. https://www.cureus.com/articles/113341-degenerative-grade-3-spondylolisthesis-management-a-
case-report-and-literature-review#!/
16. Gaillard F, O'Shea P, Rock P, et al. Spondylolisthesis grading system. Reference article,
Radiopaedia.org (Accessed on 15 May 2023) https://doi.org/10.53347/rID-20767
•
●

32. REFERENCES
17. Gagnet P, Kern K, Andrews K, Elgafy H, Ebraheim N. Spondylolysis and
spondylolisthesis: a review of the literature. Journal of orthopaedics. 2018 Jun
1;15(2):404-7.
18. Devine JG, Schenk-Kisser JM, Skelly AC. Risk factors for degenerative spondylolisthesis: a
systematic review. Evid Based Spine Care J. 2012 May;3(2):25-34. doi: 10.1055/s-0031-
1298615. PMID: 23230415; PMCID: PMC3516463.