Spondylolisthesis is a common finding in older patients with back pain, but not often identified or used in spine/pain management practices as a tool for treatment options. There is a paucity of literature on the unification of the radiological hallmarks of spondylolisthesis and how it guides interventional and surgical evaluation and management. The pathophysiology of degenerative spondylolisthesis is a subject of controversy. It is theorized that degeneration of the facets and discs can lead to segmental instability, leading to displacement over time. Kirkaldy-Willis divided degenerative spondylolisthesis into three phases: phase of dysfunction, a stage of functional abnormalities with minimal anatomic changes; phase of instability, involving further degeneration of disc, facets, and ligaments; finally, phase of re-stabilization, through osteophytes and fibrosis formation of the facets and intervertebral disc.

Faculty in this webinar will identify, display, and discuss the radiographical features that can be seen on x-ray, CT and MRI, with the intention to establish a timeline on which they clinically present. These features are routinely used in a spine clinic to assist with the diagnosis of spondylolisthesis and guide management. They consist of common structural and degenerative changes within the facet joints, posterior ligamentous complex, and the intervertebral disc. These features include: (1) Facet Morphology/Arthropathy, (2) Facet Effusion, (3) Facet Vacuum, (4) Synovial Cyst, (5) Vacuum disc and (6) Interspinous Ligament as markers of dysfunction, instability, and/or re-stabilization.

In this webinar, we will increase awareness of these radiographical markers, placing them within the framework of the currently accepted model of degenerative spondylolisthesis to help guide future research and treatment guidelines. To this aim, we will assemble a multi-disciplinary context of the current state of literature on degenerative lumbar spondylolisthesis.