Retrolisthesis (the backward slippage of one vertebra onto the vertebra immediately below) is also known as reverse spondylolisthesis and is brought on majorly by the effects of disc degeneration and usually occurs at the L3-4 or  L4-5 levels. [1]

Other causes of retrolisthesis include congenital underdevelopment of the pedicles (pedicogenic stenosis), muscle spasm of the multifidus and rotatores muscles and traumatic subluxation for instance, due to a hyperflexion injury.

Treatment by way of spinal manipulation involves gentle extension manipulation. Thrusting is avoided in the lumbar segment as this is painful for the patient. A special type of treatment table (called a Cox table) is gently brought into extension as downward pressure is manually applied to the spinous process of the affected vertebrae (see Fig. 1).

Extension manipulation being applied to a patient on a Cox table

Fig. 1. Extension manipulation being applied to a patient with L5 retrolisthesis subluxation

Lateral flexion with extension can also be used to place the articular facets of the affected vertebrae through their physiological range of motion. Other physical therapy treatment modalities (for cold or heat treatment as the case may be) will also be useful in helping to relieve radicular symptoms.

Reference 1: Cox J M. Low Back Pain. Mechanisms, Diagnosis and Treatment. 2011. 7th Edition. Wolters Kluwers/Lippincott Williams and Wilkins Publishers. Chapter 10; Facet Syndrome. Retrolisthesis Subluxation.

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