The association of mild-moderate isthmic lumbar spondylolisthesis and low back pain in middle-aged patients is weak and it only occurs in women.

This article reports on a cohort-like study of 20 women and 26 men with spondylolisthesis derived from a population of 1147 randomly selected 45-64-year-old subjects against sex-matched control subjects derived from the same source. Seventy-five percent of the spondylolisthetic subjects belonged to Meyerding class I representing mild slip. Low back symptoms during the previous day were more prevalent in women with spondylolisthesis than in control subjects (risk ratio was 7.0; 95% confidence interval 1.4-35.7), and the back pain index was higher (P = 0.028). No significant differences were seen between the groups of men in back symptoms. The use of healthcare facilities and the proportion of subjects receiving invalidity pension because of low back disease did not show any differences between the study groups of either sex. In subjects with spondylolisthesis the degree of vertebral body slip was associated with degeneration of the olisthetic intervertebral disc (P = 0.003), but it was not associated with increased occurrence of back symptoms or pain index. These data suggest that mild-moderate spondylolisthesis detected by chance in a middle-aged population does not predispose to more disabling back pain than back problems experienced by those without spondylolisthesis. However, women with spondylolisthesis have mild back symptoms more often than control subjects, suggesting that in clinical practice and future studies the sex of the patient should be considered in the evaluation of the importance of radiologic spondylolisthesis.