title: Spondylolysis and spondylolisthesis: prevalence and association with low back pain in the adult community-based population.
abstract: METHODS
  Cross-sectional study.
  
  
  OBJECTIVE
  To determine prevalence rates of spondylolysis, isthmic, and degenerative spondylolisthesis in an unselected adult community-based population; and to evaluate the association of spondylolysis, isthmic, and degenerative spondylolisthesis with low back pain (LBP).
  
  
  BACKGROUND
  Spondylolysis and spondylolisthesis are prevalent in the general population; however, the relationship between these conditions and LBP is controversial.
  
  
  METHODS
  This study was an ancillary project to the Framingham Heart Study. A sample of 3529 participants of the Framingham Heart Study aged 40 to 80 years underwent multidetector CT imaging to assess aortic calcification. One hundred eighty-eight individuals were consecutively enrolled in this study to assess radiographic features potentially associated with LBP. The occurrence of LBP in the preceding 12 months was evaluated using a self-report questionnaire. The presence of spondylolysis and spondylolisthesis was characterized by CT imaging. We used multiple logistic regression models to examine the association between spondylolysis, spondylolisthesis, and LBP, while adjusting for gender, age, and BMI.
  
  
  RESULTS
  Twenty-one study subjects demonstrated spondylolysis on computed tomography (CT) imaging. The male-to-female ratio was approximately 3:1. Twenty-one percent of subjects with bilateral spondylolytic defects demonstrated no measurable spondylolisthesis. The male-to-female ratio of degenerative spondylolisthesis was 1:3, and the prevalence of degenerative spondylolisthesis increased from the fifth through 8 decades of life. Thirty-eight subjects (20.4%) reported significant LBP. No significant association was identified between spondylolysis, isthmic spondylolisthesis, or degenerative spondylolisthesis, and the occurrence of LBP.
  
  
  CONCLUSIONS
  Based on CT imaging of an unselected community-based population, the prevalence of lumbar spondylolysis is 11.5%, nearly twice the prevalence of previous plain radiograph-based studies. This study did not reveal a significant association between the observation of spondylolysis on CT and the occurrence of LBP, suggesting that the condition does not seem to represent a major cause of LBP in the general population.
authors.affiliation: Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, Massachusetts, USA.
authors.forename: Leonid
authors.initials: L
authors.lastname: Kalichman
authors.forename: David H
authors.initials: DH
authors.lastname: Kim
authors.forename: Ling
authors.initials: L
authors.lastname: Li
authors.forename: Ali
authors.initials: A
authors.lastname: Guermazi
authors.forename: Valery
authors.initials: V
authors.lastname: Berkin
authors.forename: David J
authors.initials: DJ
authors.lastname: Hunter
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015984:Causality; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D016015:Logistic Models; D017116:Low Back Pain / Q000453:epidemiology*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015995:Prevalence; D013168:Spondylolisthesis / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000473:pathology*; D013169:Spondylolysis / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000473:pathology*; D014057:Tomography, X-Ray Computed