# Spondylolysis / spondylolisthesis - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - 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 date: 2026-08 ## Verified against - Spondylolysis / spondylolisthesis - disease-level clinical article (spondylolysis-spondylolisthesis-clinical.txt) - MSF Essential Drugs 2024 (ibuprofen oral monograph) ## Treatment metadata - Ibuprofen — 400 mg — oral.solid - Referral & safety-netting (no drug therapy) ## Complete treatment card ```text SPONDYLOLYSIS / SPONDYLOLISTHESIS 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) Review status: REVIEWED against Spondylolysis / spondylolisthesis - disease-level clinical article (spondylolysis-spondylolisthesis-clinical.txt), MSF Essential Drugs 2024 (ibuprofen oral monograph) (2026-08) 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 Source StatPearls "Spondylolisthesis" - disease-level clinical article Status traced to the source above Rx: Pain | Main treatment PAIN 1. IBUPROFEN [1st line] Adult 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. Peds 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.) 3kg -> 15-30 mg/dose 4kg -> 20-40 mg/dose 5kg -> 25-50 mg/dose 6kg -> 30-60 mg/dose 7kg -> 35-70 mg/dose 8kg -> 40-80 mg/dose 9kg -> 45-90 mg/dose 10kg -> 50-100 mg/dose 11kg -> 55-110 mg/dose 12kg -> 60-120 mg/dose 13kg -> 65-130 mg/dose 14kg -> 70-140 mg/dose 15kg -> 75-150 mg/dose 16kg -> 80-160 mg/dose 17kg -> 85-170 mg/dose 18kg -> 90-180 mg/dose 19kg -> 95-190 mg/dose 20kg -> 100-200 mg/dose 21kg -> 105-210 mg/dose 22kg -> 110-220 mg/dose 23kg -> 115-230 mg/dose 24kg -> 120-240 mg/dose 25kg -> 125-250 mg/dose 26kg -> 130-260 mg/dose 27kg -> 135-270 mg/dose 28kg -> 140-280 mg/dose 29kg -> 145-290 mg/dose 30kg -> 150-300 mg/dose 31kg -> 155-310 mg/dose 32kg -> 160-320 mg/dose 33kg -> 165-330 mg/dose 34kg -> 170-340 mg/dose 35kg -> 175-350 mg/dose 36kg -> 180-360 mg/dose 37kg -> 185-370 mg/dose 38kg -> 190-380 mg/dose 39kg -> 195-390 mg/dose 40kg -> 200-400 mg/dose 41kg -> 205-400 mg/dose (upper capped) 42kg -> 210-400 mg/dose (upper capped) 43kg -> 215-400 mg/dose (upper capped) 44kg -> 220-400 mg/dose (upper capped) 45kg -> 225-400 mg/dose (upper capped) 46kg -> 230-400 mg/dose (upper capped) 47kg -> 235-400 mg/dose (upper capped) 48kg -> 240-400 mg/dose (upper capped) 49kg -> 245-400 mg/dose (upper capped) 50kg -> 250-400 mg/dose (upper capped) 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. Caution 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. Egypt DAJUANOFEN 400 MG 20 F.C. TABS. COPAD PHARMA 5.00 EGP (0.25/unit) FLABU 400MG 10 F.C.TAB. DELTA PHARMA 3.75 EGP (0.38/unit) NOVA-PROFEN 400MG 30 F.C. TABLETS SANOFI 12.75 EGP (0.42/unit) IBUPROFEN 400 MG 10 TAB. SEDICO 6.00 EGP (0.60/unit) MAFO 400 MG 30 F.C.TABS EIPICO 42.00 EGP (1.40/unit) BRUFEN 400 MG 30 TABS. KAHIRA > ABBO... 78.00 EGP (2.60/unit) PROFUSOL 400MG 20 S.G CAPS. EUROPEAN EGYP... 31.00 EGP ANALGIPROF 400 MG 25 SACHETS EVA PHARMA 37.50 EGP NOVA-PROFEN 100MG/5ML ORAL SUSP. 100ML SANOFI 2.25 EGP -> ? strength differs, ? different route - not oral solid BRUFEMOL-N SUSP. 60 ML ARAB DRUG COM... 4.50 EGP -> ? strength differs, ? different route - not oral solid MAIN TREATMENT 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult 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 Peds A child is dosed from the drug rows above, by weight. The referral threshold and the safety-netting are the same at any age. 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. Caution 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. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)