European Radiology

, Volume 24, Issue 2, pp 441–448 | Cite as

Prevalence and risk factors of lumbar spondylolisthesis in elderly Chinese men and women

  • Lai-Chang He
  • Yi-Xiang J WangEmail author
  • Jing-Shan Gong
  • James F Griffith
  • Xian-Jun Zeng
  • Anthony WL Kwok
  • Jason CS Leung
  • Timothy Kwok
  • Anil T Ahuja
  • Ping Chung Leung



A screening survey for osteoporotic fractures in men and women in Hong Kong represents the first large-scale prospective population-based study on bone health in elderly (≥65 years) Chinese men and women. This study aims to identify the prevalence and potential risk factors of lumbar spondylolisthesis in these subjects.


The lateral lumbar radiographs of 1,994 male and 1,996 female patients were analysed using the Meyerding classification.


Amongst the men, 380 (19.1 %) had at least one spondylolisthesis and 43 (11.3 %) had slips at two or more levels; 283 had anterolisthesis, 85 had retrolisthesis, whereas 12 subjects had both anterolisthesis and retrolisthesis. Amongst the women, 499 (25.0 %) had at least one spondylolisthesis and 69 (13.8 %) had slips at two or more levels; 459 had anterolisthesis, 34 had retrolisthesis, whereas 6 subjects had both anterolisthesis and retrolisthesis. Advanced age, short height, higher body mass index (BMI), higher bone mineral density (BMD) and degenerative arthritis are associated with spondylolisthesis. Lower Physical Activity Scale for the Elderly (PASE) score was associated with spondylolisthesis in men; higher body weight, angina and lower grip strength were associated with spondylolisthesis in women.


The male/female ratio of lumbar spondylolisthesis prevalence was 1:1.3 in elderly Chinese. Men are more likely to have retrolisthesis.

Key Points

• The prevalence of spondylolisthesis is 19.1 % in elderly Chinese men.

• The prevalence of spondylolisthesis is 25.0 % in elderly Chinese women.

• Men are more likely to have retrolisthesis.

• Anterolisthesis is most commonly seen at the L4/L5 level.

• Retrolisthesis is most commonly seen at the L3/L4 level.


Prevalence Risk factors Spondylolisthesis Chinese Vertebrae 



This study was funded by the National Institute of Health R01 Grant AR049439-01A1 and the Research Grants Council Earmarked Grant CUHK 4101/02 M.


  1. 1.
    Wiltse LL, Newman PH, Macnab I (1976) Classification of spondylolisis and spondylolisthesis. Clin Orthop Relat Res 23–294Google Scholar
  2. 2.
    Fredrickson BE, Baker D, McHolick WJ et al (1984) The natural history of spondylolysis and spondylolisthesis. J Bone Joint Surg Am 66:699–707PubMedGoogle Scholar
  3. 3.
    Beutler WJ, Fredrickson BE, Murtland A et al (2003) The natural history of spondylolysis and spondylolisthesis: 45-year follow-up evaluation. Spine 28:1027–1035PubMedGoogle Scholar
  4. 4.
    North American Spine Society (2008) Clinical guidelines for multidisciplinary spine care. Diagnosis and treatment of degenerative lumbar spondylolisthesis. North American Spine Society, Burr RidgeGoogle Scholar
  5. 5.
    Rosenberg NJ (1975) Degenerative spondylolisthesis. Predisposing factors J Bone Joint Surg Am 57:467–474Google Scholar
  6. 6.
    Moller H, Sundin A, Hedlund R (2000) Symptoms, signs, and functional disability in adult spondylolisthesis. Spine 25:683–690PubMedCrossRefGoogle Scholar
  7. 7.
    Weinstein JN, Lurie JD, Olson PR et al (2006) United States’ trends and regional variations in lumbar spine surgery: 1992–2003. Spine 31:2707–2714PubMedCentralPubMedGoogle Scholar
  8. 8.
    Deyo RA, Gray DT, Kreuter W et al (2005) United States trends in lumbar fusion surgery for degenerative conditions. Spine 30:1441–1445PubMedCrossRefGoogle Scholar
  9. 9.
    Fischgrund JS, Mackay M, Herkowits HN et al (1997) 1997 Volvo award winner in clinical studies. Degenerative lumbar spondylolisthesis with spinal stenosis: a prospective, randomized study comparing decompressive laminectomy and arthrodesis with and without spinal instrumentation. Spine 22:2807–2812PubMedCrossRefGoogle Scholar
  10. 10.
    Kornblum MB, Fischgrund JS, Herkowitz HN et al (2004) Degenerative lumbar spondylolisthesis with spinal stenosis: a prospective long-term study comparing fusion and pseudarthrosis. Spine 29:726–733PubMedCrossRefGoogle Scholar
  11. 11.
    Vibert BT, Sliva CD, Herkowitz HN (2006) Treatment of instability and spondylolisthesis: surgical versus nonsurgical treatment. Clin Orthop Relat Res 443:222–227PubMedCrossRefGoogle Scholar
  12. 12.
    Weinstein JN, Lurie JD, Tosteson TD et al (2007) Surgical versus nonsurgical treatment for lumbar degenerative spondylolisthesis. N Engl J Med 356:2257–2270PubMedCentralPubMedCrossRefGoogle Scholar
  13. 13.
    Chen JC, Chan WP, Katz JN et al (2004) Occupational and personal factors associated with acquired lumbar spondylolisthesis of urban taxi drivers. Occup Environ Med 61:992–998PubMedCrossRefGoogle Scholar
  14. 14.
    Jacobsen S, Sonne-Holm S, Rovsing H et al (2007) Degenerative lumbar spondylolisthesis: an epidemiological perspective: The Copenhagen Osteoarthritis Study. Spine 32:120–125PubMedCrossRefGoogle Scholar
  15. 15.
    Vogt MT, Rubin D, Valentin RS et al (1998) Lumbar olisthesis and lower back symptoms in elderly white women. The study of osteoporotic fractures. Spine 23:2640–2647PubMedCrossRefGoogle Scholar
  16. 16.
    Kauppila LI, Eustace S, Kiel DP et al (1998) Degenerative displacement of lumbar vertebrae. A 25-year follow-up study in Framingham. Spine 23:1868–1873PubMedCrossRefGoogle Scholar
  17. 17.
    Kalichman L, Kim DH, Li L et al (2009) Spondylolysis and spondylolisthesis: Prevalence and association with low back pain in the adult community-based population. Spine 34:199–205PubMedCentralPubMedCrossRefGoogle Scholar
  18. 18.
    Denard PJ, Holton KF, Miller J et al (2010) Lumbar spondylolisthesis among elderly men: prevalence, correlates and progression. Spine 35:1072–1078PubMedCentralPubMedCrossRefGoogle Scholar
  19. 19.
    Fitzgerald J, Newman P (1976) Degenerative spondylolisthesis. J Bone Joint Surg Br 58:184–192PubMedGoogle Scholar
  20. 20.
    Herkowitz H, Kurz L (1991) Degenerative lumbar spondylolisthesis with spinal stenosis. J Bone Joint Surg Am 73:802–808PubMedGoogle Scholar
  21. 21.
    Leung SS, Woo J, Ho S, Lam TH, Janus ED (1998) Hong Kong adult dietary survey, 1995. Aust J Nutrit Diet 55(Suppl 1):S11–S13Google Scholar
  22. 22.
    Liu B, Woo J, Tang N, Ng K, Ip R, Au A (2001) Assessment of total energy expenditure in a Chinese population by a physical activity questionnaire: examination of validity. Int J Food Sci Nutr 52:269–282PubMedCrossRefGoogle Scholar
  23. 23.
    Meyerding HW (1932) Spondyloptosis. Surg Gynaecol Obstet 54:371–377Google Scholar
  24. 24.
    Valkenburg HA, Haanen HCM (1982) The epidemiology of low back pain. In: White AA (ed) Proceedings from the American Association of Orthopaedic Surgeons Symposium on Low Back Pain. American Academy of Orthopaedic Surgeons, Rosemont, pp 9–22Google Scholar
  25. 25.
    Iguchi T, Wakami T, Kurihara A, Kasahara K, Yoshiya S, Nishida K (2002) Lumbar multilevel degenerative spondylolisthesis: radiological evaluation and factors related to anterolisthesis and retrolisthesis. J Spinal Disord Tech 15:93–99PubMedCrossRefGoogle Scholar
  26. 26.
    Herkowitz HN (1995) Spine update. Degenerative lumbar spondylolisthesis Spine 20:1084–1090Google Scholar
  27. 27.
    Butler D, Trafimow JH, Andersson GBJ et al (1990) Discs degenerate before facets. Spine 15:111–113PubMedCrossRefGoogle Scholar
  28. 28.
    Grobler L, Robertson P, Novotny J (1993) Etiology of spondylolisthesis. Assessment of the role played by of lumbar facet joint morphology Spine 18:80–91Google Scholar
  29. 29.
    Love T, Fagan A, Fraser R (1999) Degenerative spondylolisthesis. Developmental or acquired? J Bone Joint Surg Br 81:670–674PubMedCrossRefGoogle Scholar
  30. 30.
    Matsunaga S, Sakou TMY (1990) Natural history of degenerative spondylolisthesis. Pathogenesis and natural course of the slippage Spine 15:1204–1210Google Scholar
  31. 31.
    McAfee P, Yuan H (1982) Computed tomography in spondylolisthesis. Clin Orthop Relat Res 166:62–71PubMedGoogle Scholar
  32. 32.
    Sanderson PL, Fraser RD (1996) The influence of pregnancy on the development of degenerative spondylolisthesis. J Bone Joint Surg Br 78:951–954PubMedCrossRefGoogle Scholar
  33. 33.
    Porter RW, Hibbert C (1989) Vertebral displacement in spondylolisthesis. Clin Biomech 4:58–63CrossRefGoogle Scholar
  34. 34.
    Imada K, Matsui H, Tsuji H (1995) Oophorectomy predisposes to degenerative spondylolisthesis. J Bone Joint Surg Br 77:126–130PubMedGoogle Scholar
  35. 35.
    Wang YX, Griffith JF, Ma HT, Kwok AW, Leung JC, Yeung DK, Ahuja AT, Leung PC (2011) Relationship between gender, bone mineral density, and disc degeneration in the lumbar spine: a study in elderly subjects using an eight-level MRI-based disc degeneration grading system. Osteoporos Int 22:91–96PubMedCrossRefGoogle Scholar
  36. 36.
    Wang YX, Griffith J (2010) Effect of menopause on lumbar disk degeneration: potential etiology. Radiology 257:318–320PubMedCrossRefGoogle Scholar
  37. 37.
    Wang YX, Griffith JF, Zeng XJ, Deng M, Kwok AW, Leung JC, Ahuja AT, Kwok T, Leung P (2013) Prevalence and sex difference of lumbar disc space narrowing in elderly Chinese men and women: osteoporotic fractures in men (Hong Kong) and osteoporotic fractures in women (Hong Kong) studies. Arthritis Rheum 65:1004–1010PubMedCrossRefGoogle Scholar
  38. 38.
    Newman P, Stone K (1963) The etiology of spondylolisthesis. J Bone Joint Surg 45-B:39–59Google Scholar
  39. 39.
    Mariconda M, Galasso O, Imbimbo L et al (2007) Relationship between alterations of the lumbar spine, visualized with magnetic resonance imaging, and occupational variables. Eur Spine J16:255–266CrossRefGoogle Scholar
  40. 40.
    Farfan HF, Osteria V, Lamy C (1976) The mechanical etiology of spondylolysis and spondylolisthesis. Clin Orthop Related Res 117:40–55Google Scholar
  41. 41.
    Griffith JF, Kumta SM, Huang Y (2011) Hard arteries, weak bones. Skeletal Radiol 40:517–521PubMedCrossRefGoogle Scholar
  42. 42.
    Farfan HF (1980) The pathological anatomy of degenerative spondylolisthesis. A cadaver study Spine 5:412–418CrossRefGoogle Scholar
  43. 43.
    Lowe RW, Hayes TD, Kaye J et al (1976) Standing roentgenograms in spondylolisthesis. Clin Orthop Relat Res 10:80–84Google Scholar
  44. 44.
    Hu SS, Tribus CB, Diab M, Ghanayem AJ (2008) Spondylolisthesis and spondylolysis. Instr Course Lect 57:431–445PubMedGoogle Scholar

Copyright information

© European Society of Radiology 2013

Authors and Affiliations

  • Lai-Chang He
    • 1
    • 4
  • Yi-Xiang J Wang
    • 1
    Email author
  • Jing-Shan Gong
    • 5
  • James F Griffith
    • 1
  • Xian-Jun Zeng
    • 1
    • 2
  • Anthony WL Kwok
    • 1
    • 2
  • Jason CS Leung
    • 2
  • Timothy Kwok
    • 2
    • 3
  • Anil T Ahuja
    • 1
  • Ping Chung Leung
    • 2
  1. 1.Department of Imaging and Interventional RadiologyThe Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New TerritoriesHong Kong SARChina
  2. 2.Jockey Club Centre for Osteoporosis Care and Control, School of Public Health and Primary CareThe Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New TerritoriesHong Kong SARChina
  3. 3.Department of Medicine and TherapeuticsThe Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New TerritoriesHong Kong SARChina
  4. 4.Department of RadiologyThe First Affiliated Hospital of Nanchang UniversityNanchangChina
  5. 5.Department of Radiology, Shenzhen People’s HospitalJinan University Second Clinical Medical CollegeShenzhenChina

Personalised recommendations