Comprehensive Osteopathic Medical Licensing Examination (COMLEX USA) Practice

What best describes the pain experienced by individuals with spondylolisthesis?

1. Constant severe pain with no relief

2. Worse with bending forward

3. Worse with extension and certain movements

4. Mild discomfort that significantly worsens at night

The correct answer is: Worse with extension and certain movements

In individuals with spondylolisthesis, the pain is primarily associated with certain movements that place stress on the affected segment of the spine. The condition involves a displacement of one vertebra over another, which can lead to instability and irritation of adjacent structures, such as nerves and muscles. The pain is typically exacerbated by extension of the spine—this is when the back is arched backward, which places additional strain on the lumbar region. Activities such as standing up straight from a bent position or extending the back can often provoke pain. Patients may also experience pain during specific movements that involve lifting or twisting. This characteristic pattern of pain helps differentiate spondylolisthesis from other conditions that may have different movement-related pain profiles. For instance, pain that worsens with bending forward is more suggestive of other issues like disc herniation, where forward flexion increases pressure on the affected nerve roots, rather than the extension-related pain seen in spondylolisthesis. Understanding the mechanics of spondylolisthesis allows clinicians to better assess patient symptoms and tailor treatment options accordingly, focusing on stabilization and pain relief strategies that address the unique pain pattern of extension exacerbation.