Lumbar Multilevel Degenerative Spondylolisthesis: Radiological Evaluation and Factors Related to Anterolisthesis and Retrolisthesis

Radiographs of 3,259 outpatients with low back disorders were examined for age, gender, level, direction, degree of slip, lumbar lordosis, pedicle-facet (P-F) angle, facet shape, and disc height. Degenerative lumbar spondylolisthesis was found in 284 (8.7%) of the patients, of which 83 were excluded. Single-level spondylolisthesis was present in 132 of the 201 patients studied, including 93 cases of anterolisthesis and 39 of retrolisthesis, the former being predominant at L4 and in women and the latter at L2 and equal between the genders. Multilevel spondylolisthesis in 69 patients included 65 (94%) of two-segment slip, 21 anterior, 25 posterior, and 19 combined, and 4 cases of three-segment retrolisthesis. Factors related to anterolisthesis were increased P-F angle and W-shaped facet joint; statistically, however, no factors were found statistically related to retrolisthesis. Multilevel anterolisthesis was considered to occur from factors similar to those previously reported for single-level anterolisthesis, and the pathomechanism of retrolisthesis is different from that of anterolisthesis.