#AMBOSS::NHa-qN
"Spondylolisthesis in elderly patients is typically caused by age-related degeneration of the intervertebral disc and facet joints, leading to joint instability, which, in turn, increases corrosion of these structures. This degenerative cascade eventually results in forward subluxation of the vertebra, characteristically affecting the L4/L5 joint. Degenerative spondylolisthesis is more common in women, most likely due to increased laxity and instability of the ligamentous apparatus associated with the female hormonal pattern. Young patients more commonly have isthmic spondylolisthesis, which is caused by bilateral spondylolysis usually due to repetitive microtrauma. Isthmic spondylolisthesis typically affects the L5/S1 joint and an x-ray can show a fracture line of the vertebral arch (e.g., scotty dog with a collar sign)."