Dawaa Reference

Clinical reference

Spondylolysis / spondylolisthesis

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources3 sources

ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class LD66.01 - condition scope only, no dose · Spondylolysis - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK513333/ · MSF Essential Drugs 2024 (ibuprofen oral monograph)

Verified against2 documents
  • Spondylolysis / spondylolisthesis - disease-level clinical article (spondylolysis-spondylolisthesis-clinical.txt)
  • MSF Essential Drugs 2024 (ibuprofen oral monograph)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (6)

  • Low back pain in the lumbar form or neck pain in the cervical form is a typical complaint [back pain · neck pain]
  • Pain tends to be intermittent and worsens with flexion and extension of the affected segment
  • Direct pressure over the affected area can bring the pain on
  • Nerve root compression produces sharp, shooting pain radiating down the leg [burning pain]
  • Lying flat can ease symptoms by reducing instability and taking pressure off neural structures
  • Buttock pain, leg numbness or weakness, and trouble walking accompany the radicular picture, with bowel or bladder dysfunction being rare [numbness]

Signs — what you find (4)

  • Inspection may show a step-off deformity or an exaggerated lumbar curve [visible deformity]
  • Extension of the lumbar spine tends to reproduce the pain on exam
  • Neurological testing can turn up motor, sensory, or reflex deficits matching a nerve root
  • A positive Stork test - standing on one leg with the spine extended - reproduces the lumbar pain and points to instability [back pain]

Tests (7)

  • Routine labs are not needed unless systemic features raise concern for infection or a metabolic cause
  • AP, lateral, and flexion-extension X-rays are first-line imaging, grading slippage by the Meyerding system
  • Meyerding grading runs from grade I at 1 to 25 percent slip through grade IV at 76 to 100 percent, with grade V or spondyloptosis over 100 percent
  • Oblique films can show a pars defect as the scotty dog sign, though they add radiation and their routine use is debated
  • MRI is preferred for assessing nerve elements, disc degeneration, and soft tissue, and picks up early stress reactions and marrow edema
  • SPECT imaging can find an early stress reaction or pars defect when plain films and CT are inconclusive
  • Spinopelvic parameters - pelvic incidence, sacral slope, and pelvic tilt - matter most in high-grade slips for surgical planning

If not this — what else fits (6)

  • Degenerative disc disease mimics it but usually lacks vertebral displacement on imaging
  • Disc herniation causes similar radicular symptoms but shows extrusion or protrusion rather than vertebral slippage
  • Spinal stenosis can overlap with claudication and root compression, but imaging shows canal narrowing rather than vertebral translation
  • Sacroiliac joint dysfunction can mimic the mechanical pain but lacks neurological deficits and has its own exam findings
  • In children, spina bifida occulta or congenital scoliosis can resemble it but without true vertebral displacement
  • Discitis or osteomyelitis should be suspected with systemic features like fever and elevated inflammatory markers, showing inflammatory change without slippage on imaging

SourceStatPearls "Spondylolisthesis" - disease-level clinical article

Presentation findings are traced to the source above.

Rx: Pain | Main treatment

PAIN

1

IBUPROFEN

Pain

1st line

Strength400 mg

Formoral.solid

Adult dose and duration

200 to 400 mg 3 to 4 times daily as required, to a maximum of 1,200 mg in 24 hours. Take it with food and keep doses at least 4 hours apart. - A short course while the back pain is being brought under control, alongside the exercise programme, which is what maintains it.

Paediatric dose

5-10 mg/kg/dose [child max 400 mg]

(Child over 3 months: 5 to 10 mg/kg 3 to 4 times daily, to a maximum of 30 mg/kg in 24 hours. Nothing under 3 months of age. A single dose is capped at 400 mg, which is the adult single-dose maximum in the same MSF entry.)

Dose by weight
3kg15-30 mg/dose
4kg20-40 mg/dose
5kg25-50 mg/dose
6kg30-60 mg/dose
7kg35-70 mg/dose
8kg40-80 mg/dose
9kg45-90 mg/dose
10kg50-100 mg/dose
11kg55-110 mg/dose
12kg60-120 mg/dose
13kg65-130 mg/dose
14kg70-140 mg/dose
15kg75-150 mg/dose
16kg80-160 mg/dose
17kg85-170 mg/dose
18kg90-180 mg/dose
19kg95-190 mg/dose
20kg100-200 mg/dose
21kg105-210 mg/dose
22kg110-220 mg/dose
23kg115-230 mg/dose
24kg120-240 mg/dose
25kg125-250 mg/dose
26kg130-260 mg/dose
27kg135-270 mg/dose
28kg140-280 mg/dose
29kg145-290 mg/dose
30kg150-300 mg/dose
31kg155-310 mg/dose
32kg160-320 mg/dose
33kg165-330 mg/dose
34kg170-340 mg/dose
35kg175-350 mg/dose
36kg180-360 mg/dose
37kg185-370 mg/dose
38kg190-380 mg/dose
39kg195-390 mg/dose
40kg200-400 mg/dose
41kg205-400 mg/dose (upper capped)
42kg210-400 mg/dose (upper capped)
43kg215-400 mg/dose (upper capped)
44kg220-400 mg/dose (upper capped)
45kg225-400 mg/dose (upper capped)
46kg230-400 mg/dose (upper capped)
47kg235-400 mg/dose (upper capped)
48kg240-400 mg/dose (upper capped)
49kg245-400 mg/dose (upper capped)
50kg250-400 mg/dose (upper capped)
Dose source

MSF Essential Drugs 2024 (ibuprofen oral monograph)

Why

Non-operative management is the first-line approach and is aimed at symptom control and function; the article's conservative measures are NSAIDs, physical therapy, bracing and activity modification, with the physiotherapy built around core stabilisation, lumbar flexibility and hamstring stretching. The article names no NSAID and no amount, so the amount is MSF's.

Cautions
  • An analgesic treats the pain and not a slip that is progressing. Bowel or bladder dysfunction, saddle anaesthesia, or a progressive neurological deficit is a surgical emergency and needs immediate referral.
  • Many of these patients are adolescent athletes, so the weight-based child dose is often the relevant one, and MSF bars ibuprofen below 3 months of age.
  • The article's other options - epidural steroid injection for radicular pain, medial branch blocks, radiofrequency ablation - are specialist procedures and it states no drug, strength or volume for any of them, so none is printed.
  • Not for a child under 3 months. MSF also contra-indicates ibuprofen in allergy to any NSAID, peptic ulcer, coagulation defects, haemorrhage, surgery carrying a risk of major blood loss, severe renal or hepatic impairment, severe heart failure, severe malnutrition, uncorrected dehydration or hypovolaemia, and severe infection.
  • Avoid in pregnancy. MSF contra-indicates it outright from the beginning of the sixth month and names paracetamol as the substitute. Short-term use while breast-feeding carries no contra-indication.
  • Give with caution to an older or an asthmatic patient. Do not combine it with methotrexate, with an anticoagulant, or with another NSAID, and watch the combination with a diuretic or an ACE inhibitor - MSF's instruction there is to drink plenty of fluids to avoid renal failure.
  • It may cause allergic reactions, epigastric pain, peptic ulcer, haemorrhage and renal impairment.
Egyptian brands
Egyptian brandManufacturerIndicative price
DAJUANOFEN 400 MG 20 F.C. TABS.COPAD PHARMA5.00 EGP (0.25/unit)
FLABU 400MG 10 F.C.TAB.DELTA PHARMA3.75 EGP (0.38/unit)
NOVA-PROFEN 400MG 30 F.C. TABLETSSANOFI12.75 EGP (0.42/unit)
IBUPROFEN 400 MG 10 TAB.SEDICO6.00 EGP (0.60/unit)
MAFO 400 MG 30 F.C.TABSEIPICO42.00 EGP (1.40/unit)
BRUFEN 400 MG 30 TABS.KAHIRA > ABBOTT LABORATORIES78.00 EGP (2.60/unit)
PROFUSOL 400MG 20 S.G CAPS.EUROPEAN EGYPTIAN PHARM. IND.31.00 EGP
ANALGIPROF 400 MG 25 SACHETSEVA PHARMA37.50 EGP
NOVA-PROFEN 100MG/5ML ORAL SUSP. 100ML? strength differs? different route - not oral solidSANOFI2.25 EGP
BRUFEMOL-N SUSP. 60 ML? strength differs? different route - not oral solidARAB DRUG COMPANY (ADCO)4.50 EGP

MAIN TREATMENT

2

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line
Adult dose and duration

A pars interarticularis defect (spondylolysis) or forward slip of a vertebra (spondylolisthesis) causing low back pain, common in adolescent athletes; mild cases are managed with analgesia and activity modification, with referral if the slip progresses or neurological symptoms appear. - Refer, with advice

Paediatric dose

A child is dosed from the drug rows above, by weight. The referral threshold and the safety-netting are the same at any age.

Dose source

No dose - referral pathway, no medicine given in primary care

Why

A pars interarticularis defect (spondylolysis) or forward slip of a vertebra (spondylolisthesis) causing low back pain, common in adolescent athletes; mild cases are managed with analgesia and activity modification, with referral if the slip progresses or neurological symptoms appear.

Cautions
  • Cauda equina symptoms (saddle numbness, bladder or bowel dysfunction), progressive neurological deficit, high-grade vertebral slip.
  • The drug rows above are what the treating service gives. They are here so that the referral is an informed one and so the GP can recognise the regimen the patient comes back on - not as permission to start it without the referral.
  • RED FLAG - CAUDA EQUINA SYNDROME IS A SURGICAL EMERGENCY AND THE ANTI-INFLAMMATORY IS NOT THE ANSWER TO IT: loss of bowel or bladder control, or numbness over the buttocks, perineum and inner thighs - the area a saddle would touch. Same-day surgical referral, not a prescription.

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.