Spondylolisthesis (Spine)

Look Standing

1. Front:
   • Symmetric pelvic and shoulder height.
2. Side:
   • Hyperlordotic lumbar spine or flattened lumbar spine.
   • Short, sharp kyphosis.
3. Back:
   • Check for stigmata of dysraphism (e.g., Spina bifida).
   • Look for heart-shaped buttocks, which can be due to a retroverted pelvis and vertical sacrum.
   • Assess for scoliosis, which may be due to muscle spasm.
   • Palpate the lower lumbar spine for a step deformity.

Feel Standing

1. Pain:
   • Check for pain in the lower lumbar spine, paraspinal pain, and sacroiliac (SI) pain.
2. Step Deformity:
   • Identify any step deformity in the lower lumbar spine.
3. Paraspinal Pain:
   • Palpate for muscle spasms and tenderness in the paraspinal muscles.

Move Standing

1. Range of Motion:
   • Global restricted lumbar spine movements.
   • Schober Test:
     • Reduced, indicating restricted flexion.
2. Gait:
   • Observe a waddling gait, often normal despite pathology.

Lying Down

1. Assess Hamstrings Tightness:
   • Perform the Straight Leg Raise (SLR) or drop kick test.
2. Full Neurologic Assessment:
   • Sensory examination, tone, power, reflexes.

Finishing

1. Perianal and PR Examination:
   • Check for perianal sensation and any abnormalities during a rectal examination.
2. Vascular Examination:
   • Ensure no signs of vascular compromise.
3. Radiographs:
   • Obtain AP, lateral, and oblique views.
4. Advanced Imaging:
   • MRI or CT scan to assess for soft tissue involvement, neural compression, and precise grade of spondylolisthesis.