A retrolisthesis is a
posterior displacement of one
vertebral body
The spinal column, a defining synapomorphy shared by nearly all vertebrates,Hagfish are believed to have secondarily lost their spinal column is a moderately flexible series of vertebrae (singular vertebra), each constituting a characteristic ...
with respect to the subjacent
vertebra
The spinal column, a defining synapomorphy shared by nearly all vertebrates,Hagfish are believed to have secondarily lost their spinal column is a moderately flexible series of vertebrae (singular vertebra), each constituting a characteristic ...
to a degree less than a
luxation (dislocation). Retrolistheses are most easily diagnosed on lateral x-ray views of the spine. Views where care has been taken to expose for a true lateral view without any rotation offer the best diagnostic quality.
Retrolistheses are found most prominently in the
cervical spine
In tetrapods, cervical vertebrae (singular: vertebra) are the vertebrae of the neck, immediately below the skull. Truncal vertebrae (divided into thoracic and lumbar vertebrae in mammals) lie caudal (toward the tail) of cervical vertebrae. In sau ...
and
lumbar
In tetrapod anatomy, lumbar is an adjective that means ''of or pertaining to the abdominal segment of the torso, between the diaphragm and the sacrum.''
The lumbar region is sometimes referred to as the lower spine, or as an area of the back i ...
region but can also be seen in the
thoracic
The thorax or chest is a part of the anatomy of humans, mammals, and other tetrapod animals located between the neck and the abdomen. In insects, crustaceans, and the extinct trilobites, the thorax is one of the three main divisions of the crea ...
area.
Classification
Retrolisthesis can be classified as a form of
spondylolisthesis
Spondylolisthesis is the displacement of one spinal vertebra compared to another. While some medical dictionaries define spondylolisthesis specifically as the forward or anterior displacement of a vertebra over the vertebra inferior to it (or t ...
, since spondylolisthesis is often defined in the literature as displacement in any direction.
[Introduction to chapter 17]
in: [Page 250]
in: Yet, medical dictionaries usually define spondylolisthesis specifically as the forward or anterior displacement of a vertebra over the vertebra inferior to it (or the
sacrum
The sacrum (plural: ''sacra'' or ''sacrums''), in human anatomy, is a large, triangular bone at the base of the spine that forms by the fusing of the sacral vertebrae (S1S5) between ages 18 and 30.
The sacrum situates at the upper, back part ...
). Retrolisthesis is also called retrospondylolisthesis.
Signs and symptoms
Retrolisthesis may lead to symptoms of greatly varying intensity and distribution. This is because of the variable nature of the impact on nerve tissue and of the mechanical impact on the spinal joints themselves.
Structural instability may be experienced as a local uneasiness through to a more far reaching structural compensatory distortion involving the whole spine. If the joints are stuck in a retrolisthesis configuration there may also be changes to range of motion.
Pain may be experienced as a result of irritation to the sensory nerve roots by bone depending on the degree of displacement and the presence of any rotatory positioning of the individual spinal motion segments. The soft tissue of the disc is often caused to bulge in retrolistheses. These cannot be determined by plain films, as the x-ray passes through the soft tissue. A study by Giles et al., stated that sixteen of the thirty patients (53%) had retrolisthesis of L5 on S1 ranging from 2–9 mm; these patients had either intervertebral disc bulging or protrusion on CT examination ranging from 3–7 mm into the spinal canal. Fourteen patients (47%) without retrolisthesis (control group) did not show any retrolisthesis and the CT did not show any bulge/protrusion. On categorizing x-ray and CT pathology as being present or not, the well positioned i.e. true lateral plain x-ray film revealed a sensitivity and specificity of 100% (
5% Confidence Interval. = [89%–100% for bulge/protrusion in this preliminary study.” (
7)
Spinal cord compressions are also possible with patients experiencing pain, rigidity and neurologic signs that may follow some distance along nerves to cause symptoms at some distance from the location of the retrolisthesis.
Diagnosis
![LSV MRI T1FSE T2frFSE STIR Case04 09](https://upload.wikimedia.org/wikipedia/commons/f/fd/LSV_MRI_T1FSE_T2frFSE_STIR_Case04_09.jpg)
Complete Retrolisthesis - The body of one vertebra is posterior to both the vertebral body of the segment of the spine above as well as below.
Stairstepped Retrolisthesis - The body of one vertebra is posterior to the body of the spinal segment above, but is anterior to the one below.
Partial Retrolisthesis - The body of one vertebra is posterior to the body of the spinal segment either above or below. (
3)
Grading
Since the vertebral body in a retrolisthesis moves in a posterior direction, the grading used for spondylolistheses is of little use. It is however useful to divide the anterior to posterior dimension of the intervertebral foramina (IVF) (
4) into four equal units. A posterior displacement of up to ¼ of the IVF is graded as Grade 1, ¼ to ½ as Grade 2, ½ to ¾ as Grade 3, ¾ to total occlusion of the IVF as Grade 4. Alternatively, a measurement of the amount of displacement can also made by measuring the bone displacement in millimetres.
Retrolistheses can be caused by injury and the resulting instability of the connecting soft tissues especially ligaments, discs, muscles, tendons and fascia. They may also involve muscles through spasm as a result of nerve malfunction due to pressure caused by the posterior displacement of the vertebra encroaching on the contents of the IVF. The IVF's contents include spinal (sensory and motor) nerves, arteries, veins and lymphatic vessels which cater to the nutritional and waste removal needs of the spinal cord.
Degenerative spinal changes are often seen at the levels where a retrolisthesis is found. These changes are more pronounced as time progresses after injury, and are evidenced by end plate osteophytosis, disc damage, disc narrowing,
desiccation
Desiccation () is the state of extreme dryness, or the process of extreme drying. A desiccant is a hygroscopic (attracts and holds water) substance that induces or sustains such a state in its local vicinity in a moderately sealed container.
...
and disc bulging. “A retrolisthesis hyperloads at least one disc and puts shearing forces on the anterior longitudinal ligament, the annular rings,
nucleus pulposus
An intervertebral disc (or intervertebral fibrocartilage) lies between adjacent vertebrae in the vertebral column. Each disc forms a fibrocartilaginous joint (a symphysis), to allow slight movement of the vertebrae, to act as a ligament to hold t ...
,
cartilage
Cartilage is a resilient and smooth type of connective tissue. In tetrapods, it covers and protects the ends of long bones at the joints as articular cartilage, and is a structural component of many body parts including the rib cage, the neck an ...
end plates and
capsular ligaments. The bulging, twisting and straining tissues attached to the
endplates
The spinal column, a defining synapomorphy shared by nearly all vertebrates,Hagfish are believed to have secondarily lost their spinal column is a moderately flexible series of vertebrae (singular vertebra), each constituting a characteristic i ...
pull, push and stretch it. It is worsened with time, becoming irreversible.” This is the
etiology
Etiology (pronounced ; alternatively: aetiology or ætiology) is the study of causation or origination. The word is derived from the Greek (''aitiología'') "giving a reason for" (, ''aitía'', "cause"); and ('' -logía''). More completely, e ...
of
degenerative joint disease
Osteoarthritis (OA) is a type of degenerative joint disease that results from breakdown of joint cartilage and underlying bone which affects 1 in 7 adults in the United States. It is believed to be the fourth leading cause of disability in the w ...
. (
5)
Associated radiological findings include a vacuum phenomenon (in the nucleus pulposis of the adjacent intervertebral disc), reduction of disc height with corresponding loss of the disc space, marginal sclerosis of the adjacent vertebral bodies,
osteophyte
Osteophytes are exostoses (bony projections) that form along joint margins. They should not be confused with enthesophytes, which are bony projections that form at the attachment of a tendon or ligament. Osteophytes are not always distinguished f ...
formation and
apophyseal joint instability. With a retrolisthesis there is always a less than ideal positioning of spinal segments. There is also always a reduced anterior to posterior dimension of the spinal canal compared to the way it is supposed to be. The greater the posterior displacement, the more significant it is for producing a dysfunctional
spinal cord
The spinal cord is a long, thin, tubular structure made up of nervous tissue, which extends from the medulla oblongata in the brainstem to the lumbar region of the vertebral column (backbone). The backbone encloses the central canal of the spi ...
or even a
cauda equina syndrome
Cauda equina syndrome (CES) is a condition that occurs when the bundle of nerves below the end of the spinal cord known as the cauda equina is damaged. Signs and symptoms include low back pain, pain that radiates down the leg, numbness around th ...
.
Joint stability
Joint stability is easily evaluated by the use of
flexion
Motion, the process of movement, is described using specific anatomical terms. Motion includes movement of organs, joints, limbs, and specific sections of the body. The terminology used describes this motion according to its direction relative ...
and
extension
Extension, extend or extended may refer to:
Mathematics
Logic or set theory
* Axiom of extensionality
* Extensible cardinal
* Extension (model theory)
* Extension (predicate logic), the set of tuples of values that satisfy the predicate
* E ...
lateral
Lateral is a geometric term of location which may refer to:
Healthcare
*Lateral (anatomy), an anatomical direction
*Lateral cricoarytenoid muscle
*Lateral release (surgery), a surgical procedure on the side of a kneecap
Phonetics
*Lateral cons ...
x-ray
An X-ray, or, much less commonly, X-radiation, is a penetrating form of high-energy electromagnetic radiation. Most X-rays have a wavelength ranging from 10 picometers to 10 nanometers, corresponding to frequencies in the range 30&nb ...
views of the spine.
A summary of part of the DRE tables (
6) give a guide as to the implications of the joint instability. If either translation or angular change is determined from flexion to extension to the degree shown in the table below, then Category IV instability is present. See also
Joint stability
Joint stability refers to the resistance offered by various musculoskeletal tissues that surround a skeletal joint. Several subsystems ensure the stability of a joint. These are the passive, active and neural subsystems. It is believed that one or ...
.
Translation is a gliding motion where one bone of a joint glides over its neighbour.
Management
References
:6. Hadley, Lee A. (MD), (1973) “Anatomicoroentgenographic Studies of the Spine”. 390.
:7. Cocchiarella L., Andersson, G. “American Medical Association Guides to the Evaluation of Permanent Impairment”, 5th edition, Tables 15- 3, 15-4, 15-5.
:8. Giles, L.G.F.; Muller R.; and Winter G.J. (2006) “Lumbosacral disc bulge or protrusion suggested by lateral lumbosacral plain x-ray film – preliminary results.” Journal of Bone and Joint Surgery. British Volume, Vol 88-B, Issue SUPP_III, 450.
{{Dorsopathies
Deforming dorsopathies