LOW GRADE LUMBAR SPONDYLOLISTHESIS AT L4&L5 AND L5&S1 VERTEBRAE IN RURAL SOUTH INDIAN POPULATION

Objectives: In heavy workers incidence of low back ache is common. Low grade spondylolisthesis has more options of treatment than high grade spondylilosthesis. Therefore, this study was done to find out clinical profile of low-grade spondylolisthesis at L4-L5 and L5-S1 vertebrae in rural south Indian population. Co-relation between Modic change (MC) and grades of spondylolisthesis was also assessed. Material and Methods: Study was carried out for a period of 2 years in 40 patients with age 20-70 years with single-level L4/L5 and L5/S1 low grade spondylolisthesis (Meyerding’s grade I and II), with clinical and neurological examination, assessment of pain by Visual Analogue Score (VAS) and investigations like X ray, CT scan & MRI. Results: Out of 40 cases, 27.5% were males and female were 72.5%. The most affected age group was 40-60 years (65%). Lower back pain (LBP) was the most common symptom (100%). Straight leg raise test was positive in 81.25%. Sensory and motar deficit was seen in 45% of patients. L4-L5 level is affected in 60% of low grade spondylolisthesis cases. Incidence of Meyerding’s grade I & II were 67.5% & 32.5% respectively. In both grades females were more in distribution than males and L4-L5 vertebral level was involved significantly. Isthmic (IS) & Degenerative (DS) spondylolisthesis was 82.5% & 17.5% respectively and both incidences were more in females. In IS the level affected was L5-S1 and in DS L4-L5 level. Incidence of MC type1 is 15%, type 2 is 85% and in type3 incidence was not found in any cases. Females showed higher incidence in type1 (83.3%)&type 2 (70.6%) as compared to Males (16.6% & 29.4% respectively) but this difference was not significant(p value>0.05).Type2 Modic changes were found significantlyhigh in grade II spondylolisthesis 70%compared to 30% intype 1(p value=0.02). Summary: Incidence of low spondylolisthesis was more in females and at L4-L5. Modic changes were gender non-specific and grade specific.This study elucidates the clinical presentations of low-grade spondylolisthesis and specific changes associated with it and that will help in tracing factors responsible for it and assessing treatment outcome.