Definition Lumbar spondylolisthesis is the partial or complete slippage and misalignment of the adjacent superior and inferior vertebrae due to congenital dysplasia, trauma, and strain. The most common sites of lumbar spondylolisthesis in China are L4/L5 and L5/S1, with the highest incidence of L5/S1. The normal human lumbar spine depends on the normal position of the synovial joint, the fibrous ring of the intact disc, the surrounding ligaments, the contraction force of the dorsal extensor muscles, and the normal spinal force lines to maintain the normal relationship between them. Any weakening or loss of anti-slip factors will result in lumbosacral instability and subsequent slippage. The slipped vertebrae may cause or aggravate spinal stenosis, irritate or squeeze the nerves, and cause the corresponding clinical symptoms. The causes of slippage can be classified as congenital slippage, degenerative slippage, post-traumatic slippage, pathological slippage and medically induced slippage. According to the degree of vertebral slippage, it can be divided into four grades: Ⅰ degree: the vertebral body sliding forward does not exceed 1/4 of the sagittal diameter of the middle of the vertebral body; Ⅱ degree: more than 1/4, but not more than 2/4; Ⅲ degree: more than 2/4, but not more than 3/4; Ⅳ degree: more than 3/4 of the sagittal diameter of the vertebral body. Clinical manifestations The clinical symptoms caused by lumbar spondylolisthesis are various, and the main symptoms include the following: 1. lumbosacral pain: mostly manifested as dull pain, which may appear after exertion and reduce or disappear after bed rest. 2. sciatic nerve compression: manifested as radiating pain and numbness in the lower limbs, and the straight leg raising test is mostly positive. 3. intermittent claudication: if the nerve is compressed or combined with lumbar spinal stenosis, intermittent claudication often occurs. claudication symptoms. The involvement of cauda equina nerve may cause symptoms such as hypesthesia in the saddle area and dysfunction of urination and defecation. Lumbar spondylolisthesis is not easily observed in anterior-posterior X-rays, but lateral X-rays can clearly show the collapse pattern of the vertebral arch. Between the superior and inferior articular processes, there are often signs of sclerosis at the edges. Lateral radiographs can clearly show the signs of lumbar spondylolisthesis. Oblique radiographs can clearly show isthmus lesions. A band-like fissure may be present in the isthmus of the vertebral arch. MRI can observe the degree of lumbar nerve root compression and the degree of degeneration of each intervertebral disc. Treatment principle For lumbar spondylolisthesis below degree I, conservative treatment can be adopted, including bed rest, lumbar back muscle exercise and brace protection; supplemented by physical therapy and medication. Surgery is suitable for those who have a degree II slippage with intractable low back pain, or whose original lower back pain is aggravated, and whose regular conservative treatment is ineffective, as well as those who have severe lumbar slippage of degree III or above.