Clinical Presentation and Physiotherapy Treatment in patients with Isthmic Spondylolisthesis. Report on four cases

Introduction: Patients with symptomatic spondylolisthesis typically complain of pain that begins as incidental and worsens with activity. Usually the pain is exacerbated by specific movements, increases in weight-bearing and decreases in the sitting position; weakness of abdominal muscles is often present. The treatment is usually conservative and it seems appropriate to employ stability exercises. Clinical Features: This report on a series of case studies shows different clinical presentations of four outpatients affected by lumbar isthmic spondylolisthesis. The main clinical tests for detecting spinal instability resulted negative in some of the subjects, suggesting that in these patients spondylolisthesis was not associated with instability. In these cases, Low Back Pain (LBP) may have been due to other causes (disc displacement, excessive stiffness, etc.) Outcomes: Various outcome measures were used to investigate pain (Numerical Rating Scale), disability (Oswestry Disability Index), spinal instability (Prone Instability Test, Passive Lumbar Extension test), and muscle function (Aberrant Movement Patterns, Active Straight Leg Raising, Prone and Supine Bridge tests). Discussion: Patients with LBP and spondylolisthesis should have a well defined clinical presentation due to spinal instability. In non-specific LBP, spinal instability can also be a possible pain generator. If lumbar pain in subjects with symptomatic spondylolisthesis is related to instability, the instability tests should be positive. However, this isn’t always the case. Conclusion: This report shows varying clinical presentations and physiotherapy treatment of four patients with isthmic spondylolisthesis, suggesting that different pain generators could be treated by different conservative approaches.