Spondylolysis and spondylolisthesis: what the primary care provider should know.

PURPOSE: To provide nurse practitioners (NPs) with an overview of spondylolysis and spondylolisthesis, including the pathophysiology and etiology, incidence and prevalence, clinical presentation, diagnosis and differentials, management, and prognosis for these conditions. DATA SOURCES: Selected research, reviews, and clinical articles, and the authors' experience.
CONCLUSIONS: Spondylolysis and spondylolisthesis are two common and confusing diagnoses identified by healthcare providers in the treatment of low back pain. Symptoms can vary depending on the degree of disarticulation with radiculopathy occurring in advanced grades of spondylolisthesis. Standing, lateral lumbosacral radiographs remain the gold standard for diagnosis. The majority of patients will improve with conservative treatments. Surgical options are warranted after 6 months of failed conservative treatments for patients with radiculopathy, neurogenic claudication, progressive neurological deficits, high-grade slips, or bladder and bowel symptoms. IMPLICATIONS FOR PRACTICE: NPs can distinguish these diagnoses and perform appropriate conservative management prior to referral to specialists for surgical evaluation. NPs are important providers in interdisciplinary care by assisting patients with both psychosocial and physical management of their back pain. ©2013 The Author(s) ©2013 American Association of Nurse Practitioners.