A 59-year-old female patient is complaining of lower back pain that has lasted four days. There is no previous history of back pain, cancer, or surgery. All three of her children were delivered via C-Section. At present, the patient’s low back pain is constant.
Observe the severe anterior displacement of L5 upon the sacral base representing “spondyloptosis”. The vertebral body of L5 is triangular in its position which is an adaptation to the patient’s longstanding presence of spondylolisthesis of a “Grade V” nature (multiple arrows outlining the L5 vertebral body). There is no disc space left between the L5/S1 level. There is a rounding off of the anterior surface of the sacrum which has been referred to as “doming”. There is a curvilinear appearance on the area of the sacral base on the frontal projection which has been referred to as the “Bow Line of Brailsford.” This curvilinear radiopacity represents the L5 vertebral body superimposed on the sacral base (multiple arrows outlining the vertebral body of L5).
Also notice, there is an old, healed compression fracture with depression of the superior vertebral endplate of L2.
Be assured, patients with Grade V spondyloptosis have had their spondylolisthesis since early childhood. It’s amazing that this patient has no neurological deficit nor symptoms of radiculopathy. Years ago, if a woman was pregnant with the appearance of spondyloptosis, a Cesarean Section would have been an immediate conclusion. I have seen more than one case, with this degree of spondyloptosis, where a child has been born naturally through the pelvic canal. Of course, that patient should not deliver with a midwife or have a home birth; that patient should be in the hospital in case emergency care is necessary. In conclusion, I believe this patient’s back pain is unrelated to the advanced spondyloptosis of L5.
Courtesy of the Livesay Chiropractic Clinic, Johnson City, TN
Yochum & Rowe, Essentials of Skeletal Radiology, 3rd Edition, Lippincott, Williams and Wilkins, Chapter 5, 2005