Patient complaints include low back pain with/without buttock or thigh pain. Symptoms are "mechanical" in nature, meaning that the pain is aggravated by standing and walking and relieved by lying down. In addition, symptoms of spinal stenosis (narrowed spinal canal and intervertebral foramina) are also common. Complaints such as tired legs, numbness and tingling after walking a certain distance are common. Symptoms are partially or completely relieved by leaning forward or sitting down for a couple of minutes (Fig. 6).

• Low back pain
• Buttock pain
• Thigh pain
• Walking and standing aggravates pain
• Tired legs
• Numbness, tingling sensations

Figure 6. Lateral x-ray illustrating lumbar vertebral slippage
and instrumentation to stabilize the lumbosacral segment (L5-S1).

How Adult Slip Progression is Diagnosed
Serial x-rays (radiographs) of the lumbar spine may be helpful to establish the diagnosis. Serial radiographs are x-rays taken over a period of several years. Simple standing x-rays of the lumbar spine may suffice in patients with a sole complaint of back pain. However, in cases with accompanying sciatica (leg pain), these may not suffice. Further, computed tomography (CT) and magnetic resonance imaging (MRI) are important diagnostic tools used to assess spondylolisthesis (Fig. 7). In addition, electromyography (nerve testing) may further help to evaluate symptoms but, it is not a mandatory diagnostic procedure in every case.

Figure 7. MRI, lateral view of lumbosacral
level indicating isthmic spondylolisthesis.