The objectives of the physical examination (neurological in this case) are first to determine the presence or absence of an organic or functional lesion of the nervous system, secondly, to specify its location and extent and finally to find the cause of the disease.
Although the neurological examination is most often normal in degenerative spondylolisthesis, deficits have been found in up to 40% of patients.
The nerve root that is most commonly affected is the L5 nerve causing L5 radiculopathy. The term radiculopathy refers to the loss or decrease of the sensory or motor function of a nerve root, which is scattered in the area where a root or dorsal nerve of the spinal cord is located.
Straight leg raise test
The straight leg raise test (also known as Lasegue test), is a fundamental neurological manoeuvre during the physical examination of the patient with lower back pain aimed to assess the sciatic compromise due to lumbosacral nerve root irritation.
The straight leg raise test is rarely positive in the absence of disc herniation. Lumbar range of motion is usually diminished secondary to pain in patients with degenerative spondylolisthesis, although physiologic studies have found a tendency toward hypermobility when stressed.
-It is very common to find an absence of ankle reflexes in patients with long-standing spinal stenosis.
-It is important to look for hip or knee arthropathy, trophic changes or diminished pulses indicating vascular claudication (pain caused due to poor blood flow), and diffuse proprioceptive loss indicating peripheral neuropathy.
-Patients whose back pain is increased when lying down or at night should be evaluated to discard a tumour.
You might also want to read: Diagnosis of Degenerative Spondylolisthesis using Imaging
A careful examination is necessary to identify degenerative spondylolisthesis. Sometimes examination findings are quite normal and the diagnosis is missed.
At the London Spine Unit, we have some of the best specialists to diagnose and treat degenerative spondylolisthesis. Book an appointment to get a checkup.