Diagnosis and Roentgenologic Evidence in Spondylolisthesis

Abstract

SUBLUXATION of the spine, spondylolisthesis, formerly considered a rare deformity and reported by obstetricians as occurring more often among women, is now more frequently recognized, and is found to be common among men. This is the result of more careful analysis of clinical observations and improved technic of roentgenologic examination of patients complaining of pain low in the back. Of the 125 cases reported previous to 1900, only about 5 per cent were males. Of the patients coming to the Mayo Clinic, 71 per cent were males. Even though a clinical diagnosis of spondylolisthesis is made, the roentgenogram is indispensable in proving its presence. The roentgenologist is called on to determine the site of the subluxation, its extent, the presence of predisposing factors (such as congenital deformities), to find evidence of fracture, and to rule out complications. With modern equipment and technic the roentgenograms, properly interpreted, often permit solution of the etiologic factors: trauma and congenital defects. I believe that this deformity is not generally recognized by the medical profession; the condition had been diagnosed in less than 10 per cent of the cases I have observed. In 1921 at the Mayo Clinic, a diagnosis had been made in only two cases; in 1930 it was made in 41 cases (0.054 per cent), and, in the first nine months of 1931, in 46 cases (0.092 per cent). The average diagnosis in more than 500,000 cases was 0.023 per cent, which is probably still too low. The patients with spondylolisthesis who are usually seen in the clinic are farmers, laborers, and their wives (64 per cent). The average duration of symptoms had been 8.75 years. The ages were from 11 to 80 years; the average age was 40 years, and 80 per cent of the patients were between 20 and 60 years. Males constituted 71 per cent, and females 29 per cent, in a series of 207 patients observed at the Clinic. Patients with spondylolisthesis may not have symptoms and may not be aware of the presence of deformity; 9 per cent of the cases in the Clinic were discovered incidentally. Acute spondylolisthesis of traumatic origin may produce immediate and total disability, accompanied by excruciating pain and apparent paralysis. Symptoms may occur long after the injury and subluxation; they may be aggravated by stress and strain. Vague pain in the legs was the symptom which led to discovery of spondylolisthesis in 5 per cent of cases; pain in the legs, thighs, and hips, associated with backache, in 36 per cent. Chronic backache, however, was the principal complaint in 50 per cent. Thus, 86 per cent of these patients with spondylolisthesis complained of backache or sacro-iliac pain with or without pain in the legs. Weakness was manifest in 5 per cent and numbness in 10 per cent of the cases. In many cases, roentgenograms of the spinal column had been interpreted as negative, and, on inquiry, it was found that only anteroposterior views had been made.