Spondylolisthesis

Life University
Gonstead Study Club
Sacral Misalignments
Where Sacrum Subluxates
 At one of the sacroiliac articulations
 The lumbosacral articulation
 Sometimes both areas are involved simultaneously
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Life University Gonstead Study Club
Direction of Misalignment
 Posteriorward is the direction the sacrum slips when it misaligns

with an Ilium or the lowest lumbar
 Therefore, “posterior sacrum” has no definitive meaning unless we

specify which sacral articulation we are dealing with.
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Misalignment at the SI Joint, Ilia Versus Sacral
Involvement
 Ilium misalignment involves both ilia simultaneously, and that each
may have a listing equal in degree but opposite in direction
 Sacral misalignment involves a condition where the ilia remain

relatively intact with respect to each other, but the sacrum rotates
posteriorly away from the corresponding ilium on one side.
 This is principally a unilateral condition
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Normal Pelvis
 Distance from center of sacrum to its lateral
borders found to be equal.
 a=b
 Sacral Tubercles centered
 Ilia show no misalignment
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Pelvis with Posteriorly Rotated Sacrum
 Unequal distance from the center
of sacrum to its lateral borders, the
posterior side becoming wider.
 a>b
 Sacral tubercles displaced away

from the border of the rotated side.
 Relatively slight amount of ilium

misalignment
 Figure shows a P-L
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Measurement of Sacral Misalignment at SI
Joint
 Horizontal Plane Line of Sacrum is

drawn from equal points on either
side of sacrum, the most reliable
being the junction where the
superior articular processes join
the alae, called sacral grooves
 Horizontal Plane Line of Sacrum

will normally be parallel with the
femur head line
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Malformation of Sacrum
 If this line is not parallel with the

femur head line, then
malformation of sacrum is likely.
 Other bilateral points, such as the

superior and inferior borders of the
auricular surfaces and sacral
foramina may be used to confirm
 Bilateral structures would normally

be parallel to the horizontal plane
line if sacral symmetry exists
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Posterior and Inferior Sacrum
 Inferior tipping considered only

after malformation has been ruled
out
 Inferior tipping only occurs on the

side of posterior rotation
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Four Potential Sacral Misalignments Involving the SI
Joint
 P-R (Posterior Sacrum on the Right)
 P-L (Posterior Sacrum on the Left)
 PI-R (Posterior & Inferior Sacrum on the Right)
 PI-L (Posterior & Inferior Sacrum on the Left)
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Measurement of Sacral Misalignment at SI
Joint
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When a Posterior Rotated Sacrum Should be
Considered
 Any sum over 7mm should be
considered significant
 A difference from 4-6mm with no
misalignment factors in the ilia,
the sacrum may still be
considered posteriorly rotated
 The bodies of the vertebrae

above, including axis, must be
rotated to the side of posterior
sacrum
 No scoliosis involved
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Measuring For Sacral Inferiority
 Remember to rule out apparent
inferiority
 Roll the parallel superior from the

FHL. With the leading edge on
the higher dot draw a one-inch line
above the lower dot
 Make sure the lower side of

sacrum coincides with the side of
posterior rotation
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Rules For Correction
 Sometimes there will be no misalignment factors in the ilia at all, in

this case sacral posteriority is corrected
 This will establish a proper relationship at the SI joint
 In most cases, some amount of ilium misaignment also exists

 A proper relationship must be re-established between the posteriorly
rotated sacrum and the involved ilia
 For example: because a PIEx, PI, or Ex ilium is predominately a
posteriorward misalignment, adjusting the sacrum forward could
increase the degree of ilium posteriority
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Which to Adjust?
 Adjusting Sacrum to Ilium

 If the ilium listing is AS, In, or ASIn
 If the ilium listing is ASEx, with the AS predominating
 If the ilium listing is PIIn, with the In predominating
 Adjusting Ilium to Sacrum

 If the ilium listing is PI, Ex, or PIEx
 If the ilium listing is PIIn, with the PI predominating
 If the ilium listing is ASEx, with the Ex predominating
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Sacral Misalignment at the Lumbosacral
Articulation
 Deviation of the normal arcuate line formed by the posterior margins

of the lowest lumbar vertebra and sacrum
 The posterior margin of the body of sacrum would rest behind the body
of the lowest lumbar
 Involves only the lumbosacral articulation, and is designated a

Posterior Sacral Base
 May result from severe trauma to the pelvis, usually from a hard fall
on the buttocks
 Particularly susceptible to a base posterior is the preadolescent whose
sacral articular processes have not fully ossified
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Posterior Sacral Base
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Spondylolisthesis
 Must distinguish between a posterior sacral base and a

spondylolisthesis of lowest lumbar
 A posterior sacral base involves articular processes that have given way
 The vertebral arch of the lowest lumbar will still be intact, with the bodies
of the vertebrae above still in line
 A spondylolisthesis involves a separation defect in the vertebral

arch allowing the body of the lowest lumbar to slip forward
 The lowest lumbar will usually also go forward of the vertebral body
above
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Spondylolisthesis
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Base Posterior Versus Spondylolisthesis
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Which to Adjust?
 Sacrum is adjusted up to the lowest lumbar in either case to re-

establish normal alignment
 In the case of a spondylolisthesis, adjusting the vertebrae above is

never indicated, for the risk of increasing the lumbosacral
misalignment is too great
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Misalignment of the Coccyx
 Coccyx does not subluxate it misaligns
 Direction of misalignment is usually straight anterior, but can be

accompanied by lateral deviation
 Coccygeal listings:
 Anterior (A)
 Anterior and Right (A-R)
 Anterior and Left (A-L)
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Spondylolisthesis

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Life University

Gonstead Study Club

 The lumbosacral articulation

 Sometimes both areas are involved simultaneously

 Posteriorward is the direction the sacrum slips when it misaligns

 Therefore, “posterior sacrum” has no definitive meaning unless we

 Sacral misalignment involves a condition where the ilia remain

 Sacral Tubercles centered

 Ilia show no misalignment

 Sacral tubercles displaced away

 Relatively slight amount of ilium

 Figure shows a P-L

 Horizontal Plane Line of Sacrum is

 Horizontal Plane Line of Sacrum

 If this line is not parallel with the

 Other bilateral points, such as the

 Bilateral structures would normally

 Inferior tipping considered only

 Inferior tipping only occurs on the

 P-R (Posterior Sacrum on the Right)

 P-L (Posterior Sacrum on the Left)

 PI-R (Posterior & Inferior Sacrum on the Right)

 PI-L (Posterior & Inferior Sacrum on the Left)

 The bodies of the vertebrae

 Roll the parallel superior from the

 Make sure the lower side of

 Sometimes there will be no misalignment factors in the ilia at all, in

 In most cases, some amount of ilium misaignment also exists

 Adjusting Sacrum to Ilium

 Adjusting Ilium to Sacrum

 Deviation of the normal arcuate line formed by the posterior margins

 Involves only the lumbosacral articulation, and is designated a

 Must distinguish between a posterior sacral base and a

 A spondylolisthesis involves a separation defect in the vertebral

 Sacrum is adjusted up to the lowest lumbar in either case to re-

 In the case of a spondylolisthesis, adjusting the vertebrae above is

 Coccyx does not subluxate it misaligns

 Direction of misalignment is usually straight anterior, but can be

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