symptoms of spondylolisthesis

Spondylolisthesis

Spondylolisthesis is slippage of a lumbar vertebra in relation to the vertebra below it. Anterior slippage (anterolisthesis) is more common than posterior slippage (retrolisthesis). Spondylolisthesis has multiple causes. It can occur anywhere in the spine and is most common in the lumbar and cervical regions. Lumbar spondylolisthesis may be asymptomatic or cause pain when walking or standing for a long time. Treatment is symptomatic and includes physical therapy with lumbar stabilization.

There are five types of spondylolisthesis, categorized based on the etiology:

Type I, congenital: caused by agenesis of superior articular facet

Type II, isthmic: caused by a defect in the pars interarticularis (spondylolysis)

Type III, degenerative: caused by articular degeneration as occurs in conjunction with osteoarthritis

Type IV, traumatic: caused by fracture, dislocation, or other injury

Type V, pathologic: caused by infection, cancer, or other bony abnormalities

Spondylolisthesis usually involves the L3-L4, L4-L5, or most commonly the L5-S1 vertebrae.

Types II (isthmic) and III (degenerative) are the most common.

Type II often occurs in adolescents or young adults who are athletes and who have had only minimal trauma; the cause is a weakening of lumbar posterior elements by a defect in the pars interarticularis (spondylolysis). In most younger patients, the defect results from an overuse injury or stress fracture with the L5 pars being the most common level.

Type III (degenerative) can occur in patients who are > 60 and have  osteoarthritis ; this form is six times more common in women than men.

Anterolisthesis requires bilateral defects for type II spondylolisthesis. For type III (degenerative) there is no defect in the bone.

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Spondylolisthesis is graded according to the percentage of vertebral body length that one vertebra subluxes over the adjacent vertebra:

Grade I: 0 to 25%

Grade II: 25 to 50%

Grade III: 50 to 75%

Grade IV: 75 to 100%

Spondylolisthesis is evident on plain lumbar x-rays. The lateral view is usually used for grading. Flexion and extension views may be done to check for increased angulation or forward movement.

Mild to moderate spondylolisthesis (anterolisthesis of ≤ 50%), particularly in the young, may cause little or no pain. Spondylolisthesis can predispose to later development of foraminal stenosis . Spondylolisthesis is generally stable over time (ie, permanent and limited in degree).

Treatment of spondylolisthesis is usually symptomatic. Physical therapy with lumbar stabilization exercises may be helpful.

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What Is Spondylolisthesis?

Types of spondylolisthesis, frequently asked questions.

Spondylolisthesis is a condition in which a vertebra in the lumbar (lower) spine slips out of normal position, sliding forward (or sometimes backward) relative to the vertebra beneath it. It can be the result of an injury, lower back stress associated with sports, or age-related changes in the spine.

Depending on the extent of movement of the vertebra involved, symptoms can range from none at all to severe pain caused by pressure on a  spinal nerve .

Spondylolisthesis usually is diagnosed with an X-ray . Low-grade spondylolisthesis may be relieved with non-invasive measures, while more severe cases may require a surgical procedure.

Hero Images / Digital Vision / Getty Images

The vertebrae are the box-shaped bones stacked on top of each other that make up the spinal column. Each vertebra should be neatly stacked on the one above and below. The spinal column has a normal S-shaped curvature when viewed from the side, but each vertebra should be neatly positioned on top of the vertebra below.

In spondylolisthesis, the vertebrae shift from their normal position. As a result, the condition is often referred to as "slipped vertebrae." Forward slippage is called anterolisthesis and backward slippage is called retrolisthesis .

Most often, this is a very slowly progressive condition with different types that include:

• Isthmic spondylolisthesis:  This results from spondylolysis, a condition that leads to small stress fractures (breaks) in the vertebrae. In some cases, the fractures weaken the bone so much that it slips out of place.
• Degenerative spondylolisthesis:  Degenerative spondylolisthesis is related to spine changes that tend to occur with age. For example, the discs can start to dry up and become brittle; as this occurs, they shrink and may bulge. Spinal arthritis is another age-related condition. Degenerative spondylolisthesis can cause  spinal stenosis , in which the bones narrow and put pressure on the spinal cord.
• Congenital spondylolisthesis:  Congenital spondylolisthesis results from abnormal bone formation that is present from birth, leaving the vertebrae vulnerable to slipping.

Less common forms of the condition include:

• Traumatic spondylolisthesis:  With this, a spinal fracture or vertebral slipping occurs due to injury.
• Pathological spondylolisthesis:  In this case, spondylolisthesis occurs due to another disease, such as  osteoporosis , a tumor, or an infection.
• Post-surgical spondylolisthesis:  This occurs when spine surgery results in slippage of the vertebrae.

Many people with spondylolisthesis have no obvious symptoms. Sometimes the condition is not discovered until an X-ray is taken for an unrelated injury or condition.

The most common symptom is lower back pain that can radiate to the buttocks and down the backs of the thighs. The symptoms may get worse during activity and subside during rest. Specifically, you may find that symptoms disappear when you bend forward or sit and get worse when you stand or walk.

This is because sitting and bending open up the space where spinal nerves are located, relieving pressure. Other potential symptoms include:

• Muscle spasms
• Tight hamstrings (muscles in the back of the thigh)
• Difficulty walking or standing for a long period of time
• Changes in gait

Severe or high-grade slips may result in pressure on a nearby spinal nerve root, causing tingling, numbness, or weakness in one or both legs.

Children involved in sports such as gymnastics, football, and diving tend to be at an increased risk for isthmic spondylolisthesis. These sports require repeated spinal hyperextension , which can cause a stress fracture of the pars interarticularis in the L5 vertebra.

Unless the hyperextension exercises are stopped to give the bone time to heal, scar tissue can form and prevent the bones from ever healing properly. This can lead to spondylolysis or stress fractures in the pars interarticularis, a condition that commonly leads to spondylolisthesis.

It's possible to be born with spondylolysis or spondylolisthesis, but both conditions can also develop from an injury, a disease, or a tumor.

Genetics may play a role in the risk of spondylolisthesis. There have been higher reports of spondylolisthesis in certain ethnic groups, namely Inuit Eskimos and Black Americans assigned female at birth .

Degenerative spondylolisthesis, the most common type, tends to affect adults over the age of 40. Older age, female gender, being overweight or obese, and conditions that can affect the spine, such as degenerative disc disease (DDD) and osteoarthritis , are thought to be factors that elevate the risk for this condition.

A healthcare professional will first talk to you and/or your child about symptoms, medical history, general health, and any participation in sports or physical activities. Then, they will examine the spine, looking for areas of tenderness or muscle spasms, and assess whether there are problems with gait or posture.

Next, your practitioner may order imaging studies, including:

• X-rays: These help distinguish between spondylolysis and spondylolisthesis. An X-ray taken from the side is also used to assign a grade between I and V, based on the severity of the slippage.
• Computed tomography (CT) scans :  These provide greater detail than X-rays and help a healthcare professional prescribe the most appropriate treatment.
• Magnetic resonance imaging (MRI) scans :  An MRI focuses on the body's soft tissues and can reveal damage to the intervertebral disks between the vertebrae or compression of spinal nerve roots.

There are five spondylolisthesis grades, each representing an incremental 25% increase of slippage in the vertebra.

Spondylolisthesis is treated according to the grade. For grades I and II, conservative treatments are often sufficient, including nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, physical therapy, home exercises, stretching, and the use of a brace.  In physical therapy,  core strengthening and stabilization  exercises are emphasized.

Over the course of treatment, periodic X-rays may be taken to determine whether the vertebra is changing position.

For high grades or progressive worsening,  spinal fusion surgery  may be recommended. During this procedure, the affected vertebrae are fused together so that they heal into a single, solid bone.

During the procedure, the surgeon will realign the vertebrae in the lumbar spine. Small pieces of bone—called a bone graft—are then placed into the spaces between the vertebrae to be fused. Over time, the bones grow together, much like when a broken bone heals. Metal screws and rods may be installed to further stabilize the spine and improve the chances of successful fusion.

In some cases, patients with high-grade slippage also have compression of the spinal nerve roots. If this is the case, a procedure known as spinal decompression can help open up the spinal canal and relieve pressure on the nerves.

Spondylolisthesis is a spine condition in which a vertebra slips out of position. This may cause symptoms like low back pain and back stiffness. Young athletes are often at increased risk for spondylolisthesis as overextending the spine—which commonly happens in sports like football and gymnastics—is one of the most common causes of the condition.

To diagnose spondylolisthesis, a healthcare professional will review a person's symptoms and medical history, and they'll use imaging tests like X-rays and CT scans to analyze the spine and determine the severity, or grade, of the problem.

Lower-grade cases of spondylolisthesis typically respond well to conservative treatment like anti-inflammatory medication and physical therapy, while higher-grade cases may require surgery.

In most cases, it's possible to resume activities, including sports, once the condition has been treated. If symptoms reappear after treatment, tell a healthcare provider so that they can determine what strategies are needed to relieve them and restore your quality of life.

Spondylosis is a condition in which there is a stress fracture or weakness in a vertebra. Spondylolisthesis occurs when a vertebra slips out of position. Spondylosis may lead to spondylolisthesis, as a fracture in a vertebra may cause it to slip.

If you have spondylolisthesis, you may qualify for disability insurance if symptoms are severe and greatly impact your quality of life.

Those with spondylolisthesis should avoid movements that put great stress on the spine, such as lifting heavy objects. They should also avoid participating in sports that can lead to overtwisting or overextending the spine, like gymnastics and wrestling, until after treatment.

Cleveland Clinic. Spondylolisthesis .

Cedars Sinai. Spondylolisthesis .

American Academy of Orthopaedic Surgeons.  Spondylolysis and spondylolisthesis .

NYU Langone Health. Diagnosing spondylolisthesis in adults .

Wang YXJ, Káplár Z, Deng M, Leung JCS. Lumbar degenerative spondylolisthesis epidemiology: A systematic review with a focus on gender-specific and age-specific prevalence . J Orthop Translat . 2016;11:39-52. doi:10.1016/j.jot.2016.11.001

Tedyanto EH. Relationship between body mass index and radiological features of spondylolisthesis . International Journal of Science and Research. 2020;9(2):2319-7064. doi:10.21275/SR20215210921

Koslosky E, Gendelberg D. Classification in brief: The Meyerding classification system of spondylolisthesis . Clin Orthop Relat Res . 2020;478(5):1125-1130. doi:10.1097/CORR.0000000000001153

American Academy of Orthopaedic Surgeons. Spinal fusion .

Cleveland Clinic. Spondylolysis .

By Jonathan Cluett, MD Dr. Cluett is board-certified in orthopedic surgery. He served as assistant team physician to Chivas USA (Major League Soccer) and the U.S. national soccer teams.

Spondylolisthesis

Spondylolisthesis is where one of the bones in your spine, called a vertebra, slips forward. It can be painful, but there are treatments that can help.

It may happen anywhere along the spine, but is most common in the lower back.

Check if you have spondylolisthesis

The main symptoms of spondylolisthesis include:

• pain in your lower back, often worse when standing or walking and relieved when sitting or bending forward
• pain spreading to your bottom or thighs
• tight hamstrings (the muscles in the back of your thighs)
• pain, numbness or tingling spreading from your lower back down 1 leg ( sciatica )

Spondylolisthesis does not always cause symptoms.

Spondylolisthesis is not the same as a slipped disc . This is when the tissue between the bones in your spine pushes out.

Non-urgent advice: See a GP if:

• you have lower back pain that does not go away after 3 to 4 weeks
• you have pain in your thighs or bottom that does not go away after 3 to 4 weeks
• you're finding it difficult to walk or stand up straight
• you're worried about the pain or you're struggling to cope
• you have pain, numbness and tingling down 1 leg for more than 3 or 4 weeks

What happens at your GP appointment

If you have symptoms of spondylolisthesis, the GP may examine your back.

They may also ask you to lie down and raise 1 leg straight up in the air. This is painful if you have tight hamstrings or sciatica caused by spondylolisthesis.

The GP may arrange an X-ray to see if a bone in your spine has slipped forward.

You may have other scans, such as an MRI scan , if you have pain, numbness or weakness in your legs.

Treatments for spondylolisthesis

Treatments for spondylolisthesis depend on the symptoms you have and how severe they are.

Common treatments include:

• avoiding activities that make symptoms worse, such as bending, lifting, athletics and gymnastics
• taking anti-inflammatory painkillers such as ibuprofen or stronger painkillers on prescription
• steroid injections in your back to relieve pain, numbness and tingling in your leg
• physiotherapy to strengthen and stretch the muscles in your lower back, tummy and legs

The GP may refer you to a physiotherapist, or you can refer yourself in some areas.

Waiting times for physiotherapy on the NHS can be long. You can also get it privately.

Surgery for spondylolisthesis

The GP may refer you to a specialist for back surgery if other treatments do not work.

Types of surgery include:

• spinal fusion – the slipped bone (vertebra) is joined to the bone below with metal rods, screws and a bone graft
• lumbar decompression – a procedure to relieve pressure on the compressed spinal nerves

The operation is done under general anaesthetic , which means you will not be awake.

Recovery from surgery can take several weeks, but if often improves many of the symptoms of spondylolisthesis.

Talk to your surgeon about the risks and benefits of spinal surgery.

Causes of spondylolisthesis

Spondylolisthesis can:

• happen as you get older – the bones of the spine can weaken with age
• run in families
• be caused by a tiny crack in a bone (stress fracture) – this is more common in athletes and gymnasts

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Spondylolisthesis

Spondylolisthesis is a displacement of a vertebra in which the bone slides out of its proper position onto the bone below it. Most often, this displacement occurs following a break or fracture.

Surgery may be necessary to correct the condition if too much movement occurs and the bones begin to press on nerves.

Other complications may include:

• Chronic back pain
• Sensation changes
• Weakness of the legs
• Temporary or permanent damage of spinal nerve roots
• Loss of bladder control

When a vertebra slips out of proper alignment, discs can be damaged. To surgically correct this condition, a spinal surgeon removes the damaged disc. The slipped vertebra is then brought back into line, relieving pressure on the spinal nerve.

Types of spondylolisthesis include:

• Dysplastic spondylolisthesis , caused by a defect in part of the vertebra
• Isthmic spondylolisthesis , may be caused by repetitive trauma and is more common in athletes exposed to hyperextension motions
• Degenerative spondylolisthesis , occurs with cartilage degeneration because of arthritic changes in the joints
• Traumatic spondylolisthesis , caused by a fracture of the pedicle, lamina or facet joints as a result of direct trauma or injury to the vertebrae
• Pathologic spondylolisthesis , caused by a bone defect or abnormality, such as a tumor

Symptoms may vary from mild to severe. In some cases, there may be no symptoms at all.

Spondylolisthesis can lead to increased lordosis (also called swayback), and in later stages may result in kyphosis, or round back, as the upper spine falls off the lower.

Symptoms may include:

• Lower back pain
• Muscle tightness (tight hamstring muscle)
• Pain, numbness or tingling in the thighs and buttocks
• Tenderness in the area of the vertebra that is out of place
• Weakness in the legs
• Stiffness, causing changes in posture and gait
• A semi-kyphotic posture (leaning forward)
• A waddling gate in advanced cases
• Lower-back pain along the sciatic nerve
• Changes in bladder function

Spondylolisthesis may also produce a slipping sensation when moving into an upright position and pain when sitting and trying to stand.

Spondylolisthesis may appear in children as the result of a birth defect or sudden injury, typically occurring between the fifth bone in the lower back (lumbar vertebra) and the first bone in the sacrum (pelvis).

In adults, spondylolisthesis is the result of abnormal wear on the cartilage and bones from conditions such as arthritis , trauma from an accident or injury, or the result of a fracture, tumor or bone abnormality.

Sports that place a great deal of stress on bones may cause additional deterioration, fractures and bone disease, which may cause the bones of the spine to become weak and shift out of place.

A simple X-ray of the back will show any cracks, fractures or vertebrae slippage that are the signs of spondylolisthesis.

A CT scan or an MRI may be used to further diagnose the extent of the damage and possible treatments.

Treatment for spondylolisthesis will depend on the severity of the vertebra shift. Stretching and exercise may improve some cases as back muscles strengthen.

Non-invasive treatments include:

• Heat/Ice application
• Pain medicine (Tylenol and/or NSAIDS)
• Physical therapy
• Epidural injections

Surgery may be needed to fuse the shifted vertebrae if the patient has:

• Severe pain that does not get better with treatment
• A severe shift of a spine bone
• Weakness of muscles in a leg or both legs

Surgical process realigns the vertebrae, fixing them in place with a small rod that is attached with a pedicle screw, adding stability to the spine with or without the addition to an interbody (bone graft or cage) placed between the vertebra from the side or front.

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Spondylolisthesis: Definition, Causes, Symptoms, and Treatment

by Dave Harrison, MD • Last updated November 26, 2022

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What is Spondylolisthesis?

The spine is comprised of 33 bones, called vertebra , stacked on top of each other interspaced by discs . Spondylolisthesis is a condition where one vertebra slips forward or backwards relative to the vertebra below. More specifically, retrolisthesis is when the vertebra slips posteriorly or backwards, and anterolisthesis is when the vertebra slips anteriorly or forward.

Spondylosis vs Spondylolisthesis

Spondylosis and Spondylolisthesis are different conditions. They can be related but are not the same. Spondylosis refers to a fracture of a small bone, called the pars interarticularis, which connects the facet joint of the vertebra to the one below. This may lead to instability and ultimately slippage of the vertebra. Spondylolisthesis, on the other hand, refers to slippage of the vertebra in relation to the one below.

Types and Causes of Spondylolisthesis

There are several types of spondylolisthesis, often classified by their underlying cause:

Degenerative Spondylolisthesis

Degenerative spondylolisthesis is the most common cause, and is due to general wear and tear on the spine. Overtime, the bones and ligaments which hold the spine together may become weak and unstable.

Isthmic Spondylolisthesis

Isthmic spondylolisthesis is the result of another condition, called “ spondylosis “. Spondylosis refers to a fracture of a small bone, called the pars interarticularis, which connects the facet joint of the vertebra to the one below. If this interconnecting bone is broken, it can lead to slippage of the vertebra. This can sometimes occur during childhood or adolsence but go unnoticed until adulthood when degenerative changes cause worsening slippage.

Congenital Spondylolisthesis

Congenital spondylolisthesis occurs when the bones do not form correctly during fetal development

Traumatic Spondylolisthesis

Traumatic spondylolisthesis is the result of an injury such as a motor vehicle crash

Pathologic Spondyloslisthesis

Pathologic spondylolisthesis is when other disorders weaken the points of attachment in the spine. This includes osteoporosis, tumors, or infection that affect the bones and ligaments causing them to slip.

Iatrogenic Spondylolisthesis

Iatrogenic spondylolisthesis is the result of a prior surgery. Some operations of the spine, such as a laminectomy, may lead to instability. This can cause the vertebra to slip post operatively.

Spondylolisthesis Grades

Spondylolisthesis is classified based on the degree of slippage relative to the vertebra below

• Grade 1 : 1 – 25 % forward slip. This degree of slippage is usually asymptomatic.
• Grade 2: 26 – 50 % forward slip. May cause mild symptoms such as stiffness and pain in your lower back after physical activity, but it’s not severe enough to affect your everyday activities.
• Grade 3 : 51 – 75 % forward slip. May cause moderate symptoms such as pain after physical activity or sitting for long periods.
• Grade 4: 76 – 99% forward slip. May cause moderate to severe symptoms.
• Grade 5: Is when the vertebra has slipped completely of the spinal column. This is a severe condition known as “spondyloptysis”.

Symptoms of Spondylolisthesis

Spondylolisthesis can cause compression of spinal nerves and in severe cases, the spinal cord. The symptoms will depend on which vertebra is affected.

Cervical Spondylolisthesis (neck)

• Arm numbness or tingling
• Arm weakness

Lumbar Spondylolisthesis (low back)

• Buttock pain
• Leg numbness or tingling
• Leg weakness

Diagnosing Spondylolisthesis

Your doctor may order imaging tests to confirm the diagnosis and determine the severity of your spondylolisthesis. The most common imaging tests used include:

• X-rays : X-rays can show the alignment of the vertebrae and any signs of slippage.
• CT scan: A CT scan can provide detailed images of the bones and soft tissues in your back, allowing your doctor to see any damage or abnormalities.
• MRI: An MRI can show the spinal cord and nerves, as well as any herniated discs or other soft tissue abnormalities.

Treatments for Spondylolisthesis

Medications.

For those experiencing pain, oral medications are first line treatments. This includes non-steroidal anti-inflammatory medications (NSAIDs) such as ibuprofen, acetaminophen, or in severe cases opioids or muscle relaxants (with extreme caution). Topical medications such as lidocaine patches are also sometimes used.

Physical Therapy

Physical therapy can help improve mobility and strengthen muscles around your spine to stabilize your neck and lower back. You may also receive stretching exercises to improve flexibility and balance exercises to improve coordination.

Surgery is reserved for severe cases of spondylolisthesis in which there is a high degree of instability and symptoms of nerve compression.

In these cases a spinal fusion may be necessary. This surgery joins two or more vertebra together using rods and screws, in order to improve stability.

Reference s

• Alfieri A, Gazzeri R, Prell J, Röllinghoff M. The current management of lumbar spondylolisthesis. J Neurosurg Sci. 2013 Jun;57(2):103-13. PMID: 23676859.
• Stillerman CB, Schneider JH, Gruen JP. Evaluation and management of spondylolysis and spondylolisthesis. Clin Neurosurg. 1993;40:384-415. PMID: 8111991.

About the Author

Dave Harrison, MD

Dr. Harrison is a board certified Emergency Physician with a part time appointment at San Francisco General Medical Center and is an Assistant Clinical Professor-Volunteer at the UCSF School of Medicine. Dr. Harrison attended medical school at Tufts University and completed his Emergency Medicine residency at the University of Southern California. Dr. Harrison manages the editorial process for SpineInfo.com.

What Is Spondylolisthesis?

Spondylolisthesis is a spine condition caused when one vertebra slips over another. This condition's symptoms sometimes mimic those of other back pain conditions.

The complex design of the spinal column is a biological wonder. It comprises 33 bones at birth – some eventually fusing to become 24 bones in most adults – 23 discs and more than 40 muscles and ligaments. The spine is genuinely nature's stage for the human body's performance. And all those bones, discs, muscles and ligaments must work together perfectly for our bodies to function correctly.

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Sometimes, the mighty machinery of the spine breaks down. Many spinal conditions can affect a person throughout their lifetime, from simple back pain to spinal tumors . With so many working pieces, plenty can go wrong when the anatomy of the spine isn't quite right.

A spinal condition called spondylolisthesis occurs when one vertebra of the spine slips forward over the one beneath it. This vertebra becomes out of alignment with the rest of the spinal column. The condition appears most commonly at the base of the spine in the low back vertebrae, also known as the lumbar spine.

There are three main types of spondylolisthesis:

• Congenital : appears in the womb, before birth, when a baby's spine doesn't properly form. 
• Degenerative : happens over time, usually with advanced age.  
• Traumatic : occurs due to direct injury to the spine.

Diagnosis and Symptoms

Spondylolisthesis is graded by diagnosing physicians on a percentage severity scale from 1 and 5, with five being the most severe degree of vertebral slippage. An MRI is typically required to diagnose spondylolisthesis fully and to help rule out other spinal conditions, since its symptoms closely match those experienced by people with other spine issues.

In some people who have spondylolisthesis, especially those with a lower degree of vertebral slippage, the condition may cause no symptoms. However, in those who have a higher vertebral slippage score, or when the slipped vertebra is pressing on a nerve, a variety of symptoms can result, including:

• Back pain that seems to worsen with activity.
• Difficulty standing or walking, especially for long periods.
• Numbness, stiffness or tightness in the muscles of the spine, especially those in the lower back, or tightness in the hamstrings.
• Pain in the low back or buttocks, which may radiate down the legs, and is known as sciatica pain.

Exercise with Spondylolisthesis

Because certain types of activity can make spondylolisthesis symptoms worse for some people, this diagnosis can lead to inactivity. However, it's crucial to note that certain types of regular movement can help   relieve the symptoms associated with spondylolisthesis. Moving the body regularly helps to strengthen the spine and core muscles , which ultimately create better support for the spine in the long run.

When the symptoms of spondylolisthesis begin to impair mobility or proper body mechanics, that is when people should evaluate activities for safety. For example, heavy weightlifting, backbends or high-intensity sports that involve running or jumping should likely be avoided because they can make spondylolisthesis worse, which could lead to a condition called spinal stenosis.

There are still plenty of alternative activities a person with spondylolisthesis can engage in that may help provide back pain relief from the condition. These activities include gentler core exercises such as planks, yoga and gentle stretching. The key is to modify activities to reduce stress or strain on an already irritated spine.

Physical Therapy and Treatment Options

If you're unsure of what to do that won't worsen the condition, physical therapy can be a powerful and effective place to start. Under the trained guidance of a physical therapist, many people with spondylolisthesis develop the proper technique to perform exercises that help alleviate their symptoms and allow them the confidence to continue those activities at home.

From physical therapy to specific medications, most spine experts agree that conservative options are effective best places to start for spondylolisthesis treatment. Surgery is only considered when such alternatives fail to provide adequate relief or are ineffective in helping someone with spondylolisthesis return to active living.

As a complex spinal condition, it's always recommended to seek care and treatment for spondylolisthesis by a trained and experienced spine specialist .

The Health Risks of Poor Posture

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Spondylolisthesis.

Steven Tenny ; Andrew Hanna ; Christopher C. Gillis .

Affiliations

Last Update: May 22, 2023 .

• Continuing Education Activity

Spondylolisthesis is a condition that occurs when one vertebral body slips with respect to the adjacent vertebral body causing radicular or mechanical symptoms or pain. It is graded based on the degree of slippage of one vertebral body on the adjacent vertebral body. Any pathological process that can weaken the supports keeping vertebral bodies aligned can allow spondylolisthesis to occur. This activity illustrates the evaluation and management of spondylolisthesis and reviews the role of the interprofessional team in improving care for patients with this condition.

• Describe the pathophysiology of spondylolisthesis.
• Review the workup of a patient with spondylolisthesis.
• Summarize the treatment options for spondylolisthesis.
• Describee the importance of collaboration and communication among the interprofessional team in encouraging weight loss in patients to reduce symptoms and increase the quality of life in those with spondylolisthesis.
• Introduction

Spondylolisthesis is the slippage of one vertebral body with respect to the adjacent vertebral body causing mechanical or radicular symptoms or pain. It can be due to congenital, acquired, or idiopathic causes. Spondylolisthesis is graded based on the degree of slippage of one vertebral body on the adjacent vertebral body. [1]

Spondylolisthesis commonly classifies as one of five major etiologies: degenerative, isthmic, traumatic, dysplastic, or pathologic. Degenerative spondylolisthesis occurs from degenerative changes in the spine without any defect in the pars interarticularis. It is usually related to the combined facet joint and disc degeneration leading to instability and forward movement of one vertebral body relative to the adjacent vertebral body. Isthmic spondylolisthesis results from defects in the pars interarticularis. The cause of isthmic spondylolisthesis is undetermined, but a possible etiology includes microtrauma in adolescence related to sports such as wrestling, football, and gymnastics, where repeated lumbar extension occurs. Traumatic spondylolisthesis occurs after fractures of the pars interarticularis or the facet joint structure and is most common after trauma. Dysplastic spondylolisthesis is congenital and secondary to variation in the orientation of the facet joints to an abnormal alignment.  In dysplastic spondylolisthesis, the facet joints are more sagittally oriented than the typical coronal orientation. Pathologic spondylolisthesis can be from systemic causes such as bone or connective tissue disorders or a focal process, including infection, neoplasm, or iatrogenic origin. Additional risk factors for spondylolisthesis include a first-degree relative with spondylolisthesis, scoliosis, or occult spina bifida at the S1 level. [1]

• Epidemiology

Spondylolisthesis most commonly occurs in the lower lumbar spine but can also occur in the cervical spine and rarely, except for trauma, in the thoracic spine. Degenerative spondylolisthesis predominately occurs in adults and is more common in females than males with increased risk in the obese. Isthmic spondylolisthesis is more common in the adolescent and young adult population but may go unrecognized until symptoms develop in adulthood. There is a higher prevalence of isthmic spondylolisthesis in males. Dysplastic spondylolisthesis is more common in the pediatric population, with females more commonly affected than males. Current estimates for prevalence are 6 to 7% for isthmic spondylolisthesis by the age of 18 years, and up to 18% of adult patients undergoing MRI of the lumbar spine. Grade I spondylolisthesis accounts for 75% of all cases. Spondylolisthesis most commonly occurs at the L5-S1 level with an anterior translation of the L5 vertebral body on the S1 vertebral body. The L4-5 level is the second most common location for spondylolisthesis. 

• Pathophysiology

Any process that can weaken the supports keeping vertebral bodies aligned can allow spondylolisthesis to occur. As one vertebra moves relative to the adjacent vertebrae, local pain can occur from mechanical motion or radicular or myelopathic pain can occur due to compression of the exiting nerve roots or spinal cord, respectively. Pediatric patients are more likely to increase spondylolisthesis grade when going through puberty. Older patients with lower grades I or II spondylolistheses are less likely to progress to higher grades over time.

• History and Physical

Patients typically have intermittent and localized low back pain for lumbar spondylolisthesis and localized neck pain for cervical spondylolisthesis. The pain is exacerbated by flexing and extending at the affected segment, as this can cause mechanic pain from motion. Pain may be exacerbated by direct palpation of the affected segment. Pain can also be radicular in nature as the exiting nerve roots become compressed due to the narrowing of nerve foramina as one vertebra slips on the adjacent vertebrae, the traversing nerve root (root to the level below) can also be impinged through associated lateral recess narrowing, disc protrusion, or central stenosis. Pain can sometimes improve in certain positions such as lying supine. This improvement is due to the instability of the spondylolisthesis that reduces with supine posture, thus relieving the pressure on the bony elements as well as opening the spinal canal or neural foramen. Other symptoms associated with lumbar spondylolisthesis include buttock pain, numbness, or weakness in the leg(s), difficulty walking, and rarely loss of bowel or bladder control.

Anteroposterior and lateral plain films, as well as lateral flexion-extension plain films, are the standard for the initial diagnosis of spondylolisthesis. One is looking for the abnormal alignment of one vertebral body to the next as well as possible motion with flexion and extension, which would indicate instability. In isthmic spondylolisthesis, there may be a pars defect, which is termed the "Scotty dog collar." The "Scotty dog collar" shows a hyperdensity where the collar would be on the cartoon dog, which represents the fracture of the pars interarticularis. Computed tomography (CT) of the spine provides the highest sensitivity and specificity for diagnosing spondylolisthesis. Spondylolisthesis can be better appreciated on sagittal reconstructions as compared to axial CT imaging. MRI of the spine can show associated soft tissue and disc abnormalities, but it is relatively more challenging to appreciate bony detail and a potential pars defect on MRI. [2] [3]

• Treatment / Management

For grade I and II spondylolisthesis, treatment typically begins with conservative therapy, including nonsteroidal anti-inflammatory drugs (NSAIDs), heat, light exercise, traction, bracing, and/or bed rest. Approximately 10% to 15% of younger patients with low-grade spondylolisthesis will fail conservative treatment and need surgical treatment. No definitive standards exist for surgical treatment. Surgical treatment includes a varying combination of decompression, fusion with or without instrumentation, or interbody fusion. Patients with instability are more likely to require operative intervention.  Some surgeons recommend a reduction of the spondylolisthesis if able as this not only decreases foraminal narrowing but also can improve spinopelvic sagittal alignment and decrease the risk for further degenerative spinal changes in the future. The reduction can be more difficult and riskier in higher grades and impacted spondylolisthesis. [4] [5] [6] [7] [8] [2] [9] [10]

• Differential Diagnosis
• Degenerative  Lumbar Disc Disease
• Lumbar Disc Problems
• Lumbosacral Disc Injuries
• Lumbosacral Discogenic Pain Syndrome
• Lumbosacral Facet Syndrome
• Lumbosacral Radiculopathy
• Lumbosacral Spine Acute Bony Injuries
• Lumbosacral Spondylosis
• Myofascial Pain in Athletes
• Pearls and Other Issues

Meyerding’s classification of spondylolisthesis is the most commonly used grading method. Its basis is on the percentage of anterior translation relative to the adjacent level. Grade I spondylolisthesis is 1 to 25% slippage, grade II is up to 50% slippage, grade III is up to 75% slippage, and grade IV is 76-100% slippage. If there is more than 100% slippage, it is known as spondyloptosis or grade V spondylolisthesis.  

Subclasses of isthmic spondylolisthesis are subtype A (stress fractures of the pars), subtype B (elongation of the pars without overt fracture), subtype C (acute fracture of the pars).

Subclasses of pathologic spondylolisthesis are subtype A (systemic causes) and subtype B (focal processes).

• Enhancing Healthcare Team Outcomes

An interprofessional team consisting of a specialty-trained orthopedic nurse, a physical therapist, and an orthopedic surgeon or neurosurgeon will provide the best outcome and long-term care of patients with degenerative spondylolisthesis. Chiropractors may also have involvement, as they may be the first to encounter the condition on X-rays. The treating clinician will decide on the management plan, and then have the other team members engaged - surgical cases with include the nursing staff in pre-, intra-, and post-operative care, and coordinating with PT for rehabilitation. In non-operative cases, the PT will keep the rest of the team informed of progress or lack thereof. The team should encourage weight loss as weight reduction may reduce symptoms and increase the quality of life. Interprofessional collaboration, as above, will drive patient outcomes to their best results. [Level 5]

• Review Questions
• Access free multiple choice questions on this topic.
• Comment on this article.

Lumbar Spine Sagittal CT of L5-S1, Grade II Spondylolisthesis Contributed by Christopher Gillis, MD, and Steven Tenny, MD

Disclosure: Steven Tenny declares no relevant financial relationships with ineligible companies.

Disclosure: Andrew Hanna declares no relevant financial relationships with ineligible companies.

Disclosure: Christopher Gillis declares no relevant financial relationships with ineligible companies.

This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.

• Cite this Page Tenny S, Hanna A, Gillis CC. Spondylolisthesis. [Updated 2023 May 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

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• Isthmic Spondylolisthesis. [StatPearls. 2024] Isthmic Spondylolisthesis. Burton MR, Dowling TJ, Mesfin FB. StatPearls. 2024 Jan
• High-grade slippage of the lumbar spine in a rat model of spondylolisthesis: effects of cyclooxygenase-2 inhibitor on its deformity. [Spine (Phila Pa 1976). 2006] High-grade slippage of the lumbar spine in a rat model of spondylolisthesis: effects of cyclooxygenase-2 inhibitor on its deformity. Komatsubara S, Sairyo K, Katoh S, Sakamaki T, Higashino K, Yasui N. Spine (Phila Pa 1976). 2006 Jul 15; 31(16):E528-34.
• [Three vertebral reduction and fixation for revision of lumbar spondylolisthesis]. [Zhongguo Gu Shang. 2014] [Three vertebral reduction and fixation for revision of lumbar spondylolisthesis]. Li CS. Zhongguo Gu Shang. 2014 Sep; 27(9):717-21.
• Review A review of the pathomechanism of forward slippage in pediatric spondylolysis: the Tokushima theory of growth plate slippage. [J Med Invest. 2015] Review A review of the pathomechanism of forward slippage in pediatric spondylolysis: the Tokushima theory of growth plate slippage. Sairyo K, Nagamachi A, Matsuura T, Higashino K, Sakai T, Suzue N, Hamada D, Takata Y, Goto T, Nishisho T, et al. J Med Invest. 2015; 62(1-2):11-8.
• Review Spondylolisthesis. [Orthop Rev (Pavia). 2022] Review Spondylolisthesis. Li N, Scofield J, Mangham P, Cooper J, Sherman W, Kaye A. Orthop Rev (Pavia). 2022; 14(4):36917. Epub 2022 Jul 27.

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Spondylolisthesis

What is Spondylolisthesis?

Patient education video.

Types of Spondylolisthesis

What Are the Signs and Symptoms of Spondylolisthesis?

How is it diagnosed.

• Grade I – Less than 25 percent slippage
• Grade II – Between 25 and 50 percent slippage
• Grade III – Between 50 and 75 percent slippage
• Grade IV – More than 75 percent slippage
• Grade V – The upper vertebral body has slipped all the way off the front of the lower vertebral body. This is a rare situation that is called a spondyloptosis.

How is it Treated?

Surgery & treatment for spondylolisthesis, what are you looking for.

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• Degenerative Spondylolisthesis Symptoms

By: Marco Funiciello, DO, Physiatrist

Peer-Reviewed

Degenerative spondylolisthesis typically causes low back pain along with a cluster of symptoms and signs in one or both legs.

Degenerative Spondylolisthesis: Common Symptoms and Signs

Degenerative spondylolisthesis symptoms include neurogenic claudication, sciatica, and radiculopathy.

In degenerative spondylolisthesis, the degenerated facet joints and other parts of the vertebral bone tend to increase in size. The enlarged, abnormal bone then encroaches upon the central canal and/or nerve hole (foramen) causing spinal stenosis or foraminal stenosis.

In This Article:

• Degenerative Spondylolisthesis
• Degenerative Spondylolisthesis Treatment
• Surgery for Degenerative Spondylolisthesis

Degenerative Spondylolisthesis Video

These changes typically result in some combination of the following symptoms and signs.

Persistent low back pain

Low back pain caused by degenerative spondylolisthesis is usually persistent and described as a consistent dull ache, 1 Cushnie D, Johnstone R, Urquhart JC, Gurr KR, Bailey SI, Bailey CS. Quality of Life and Slip Progression in Degenerative Spondylolisthesis Treated Nonoperatively. Spine (Phila Pa 1976). 2018;43(10):E574-E579. doi:10.1097/BRS.0000000000002429 but it may also feel like a sharp, stabbing sensation for some individuals.

The pain is typically localized in the low back region and may worsen with physical activity, standing, or walking.

Neurogenic claudication

Intermittent neurogenic claudication affects around 75% of people with degenerative spondylolisthesis. It is characterized by episodes of low back pain that radiate to both legs, along with accompanying sensations of tingling, a sensation of weakness, and hamstring spasm. 2 Li N, Scofield J, Mangham P, Cooper J, Sherman W, Kaye A. Spondylolisthesis. Orthop Rev (Pavia). 2022 Jul 27;14(4):36917. doi: 10.52965/001c.36917. PMID: 35910544; PMCID: PMC9329062. , 3 García-Ramos CL, Valenzuela-González J, Baeza-Álvarez VB, Rosales-Olivarez LM, Alpizar-Aguirre A, Reyes-Sánchez A. Degenerative spondylolisthesis I: general principles. Espondilolistesis degenerativa lumbar I: principios generales. Acta Ortop Mex. 2020;34(5):324-328.. , 4 Wang YXJ, Káplár Z, Deng M, Leung JCS. Lumbar degenerative spondylolisthesis epidemiology: A systematic review with a focus on gender-specific and age-specific prevalence. J Orthop Translat. 2016;11:39-52. Published 2016 Dec 1. doi:10.1016/j.jot.2016.11.001

It is possible to have any combination of symptoms and they typically occur during walking variable distances or prolonged standing. 2 Li N, Scofield J, Mangham P, Cooper J, Sherman W, Kaye A. Spondylolisthesis. Orthop Rev (Pavia). 2022 Jul 27;14(4):36917. doi: 10.52965/001c.36917. PMID: 35910544; PMCID: PMC9329062.

Sciatica: Radiating leg pain

Back pain may radiate into the buttock, thighs, and into the leg and foot. 4 Wang YXJ, Káplár Z, Deng M, Leung JCS. Lumbar degenerative spondylolisthesis epidemiology: A systematic review with a focus on gender-specific and age-specific prevalence. J Orthop Translat. 2016;11:39-52. Published 2016 Dec 1. doi:10.1016/j.jot.2016.11.001

Radiating leg pain is commonly known as sciatica . This pain occurs due to the irritation, compression, or inflammation of spinal nerve roots in the lower back. 4 Wang YXJ, Káplár Z, Deng M, Leung JCS. Lumbar degenerative spondylolisthesis epidemiology: A systematic review with a focus on gender-specific and age-specific prevalence. J Orthop Translat. 2016;11:39-52. Published 2016 Dec 1. doi:10.1016/j.jot.2016.11.001

Radiculopathy: Abnormal sensations, weakness, and loss of muscle reflexes

When the spinal nerve roots are compressed or sufficiently inflamed and neurologic deficits are present, the condition is called radiculopathy . Radiculopathy may cause leg weakness and affect muscle reflexes. Additionally, numbness may be felt in the thigh, leg, and/or foot. 4 Wang YXJ, Káplár Z, Deng M, Leung JCS. Lumbar degenerative spondylolisthesis epidemiology: A systematic review with a focus on gender-specific and age-specific prevalence. J Orthop Translat. 2016;11:39-52. Published 2016 Dec 1. doi:10.1016/j.jot.2016.11.001

It may be challenging to perform activities that require strength, such as walking, climbing stairs, or lifting objects.

Little Known Symptoms of Degenerative Spondylolisthesis

As degenerative spondylolisthesis progresses, the symptoms may lessen due to compensatory mechanisms of the spine that increase spinal stability and prevent further progression.

However, in some individuals, the progression may continue and cause the following symptoms and signs.

Sleep disturbances 

Back pain and leg pain may cause disturbed sleep or trouble falling asleep. 5 Kalichman L, Hunter DJ. Diagnosis and conservative management of degenerative lumbar spondylolisthesis. Eur Spine J. 2008;17(3):327-335. doi:10.1007/s00586-007-0543-3

For this reason, some individuals may choose to sleep in the fetal position (sleeping on the side with knees bent close to the chest) to relieve leg symptoms. 5 Kalichman L, Hunter DJ. Diagnosis and conservative management of degenerative lumbar spondylolisthesis. Eur Spine J. 2008;17(3):327-335. doi:10.1007/s00586-007-0543-3

Restless leg syndrome

Leg pain and claudication may sometimes cause restless legs syndrome. In this condition, aching or burning pain in the calves causes an irresistible urge to move the legs continuously, causing disturbed sleep. 5 Kalichman L, Hunter DJ. Diagnosis and conservative management of degenerative lumbar spondylolisthesis. Eur Spine J. 2008;17(3):327-335. doi:10.1007/s00586-007-0543-3

Difficulty walking and imbalance

Degenerative spondylolisthesis may cause difficulty walking and maintaining balance.

As degenerative spondylolisthesis progresses, difficulties with walking and maintaining balance may be experienced. These signs arise from nerve compression caused by the slipped vertebra and associated degenerative changes,  Altered posture, muscle weakness and reduced coordination may result. 6 Studnicka K, Ampat G. Lumbosacral Spondylolisthesis. [Updated 2022 Sep 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560679/

There are many nerves in our legs that are responsible for relaying information to the brain about position and balance. If these nerves are irritated or compressed in the spine then the brain may not get the necessary information needed for good balance and posture control. 

These changes can impact mobility and function, making it harder to engage in normal daily activities.

Limited range of motion

Degenerative spondylolisthesis can affect lumbar range of motion due to the degenerative bone changes that prevent full segmental motion. Muscle spasm and stiffness may result. 

Individuals may find it challenging to twist or engage in activities that involve spinal movement. This restricted range of motion can contribute to discomfort and stiffness in the affected area.

Menopause-Related Spondylolisthesis Symptoms

The onset of menopause may accelerate normal degenerative changes of the lumbar vertebrae, discs, facet joints, and ligaments. 4 Wang YXJ, Káplár Z, Deng M, Leung JCS. Lumbar degenerative spondylolisthesis epidemiology: A systematic review with a focus on gender-specific and age-specific prevalence. J Orthop Translat. 2016;11:39-52. Published 2016 Dec 1. doi:10.1016/j.jot.2016.11.001

Typically, the symptoms associated with this progression include low back pain, stiffness, and/or pain radiating down the leg (sciatica). 4 Wang YXJ, Káplár Z, Deng M, Leung JCS. Lumbar degenerative spondylolisthesis epidemiology: A systematic review with a focus on gender-specific and age-specific prevalence. J Orthop Translat. 2016;11:39-52. Published 2016 Dec 1. doi:10.1016/j.jot.2016.11.001

Read more about Sciatica Symptoms

Diagnosis of Degenerative Spondylolisthesis

Radiating sciatica pain may occur in degenerative spondylolisthesis.

A physician trained in musculoskeletal conditions can help diagnose degenerative spondylolisthesis.

A comprehensive assessment of the patient’s history, past medical history, thorough physical examination, and review of any prior tests and imaging studies are performed.

During the review of patient history and the physical examination, physicians typically check for 7 Akkawi I, Zmerly H. Degenerative Spondylolisthesis: A Narrative Review. Acta Biomed. 2022;92(6):e2021313. Published 2022 Jan 19. doi:10.23750/abm.v92i6.10526 :

• Pain pattern. Physicians ask about localized or radiating pain and the pattern of pain distribution to check if sciatica is present.
• Postural effects. In degenerative spondylolisthesis, pain is exacerbated while bending backward and relieved when bending forward.
• History of symptoms. Neurogenic claudication and hamstring spasm while walking or standing for variable periods of time may indicate spinal stenosis caused by degenerative spondylolisthesis.

If these symptoms and signs are noticed, the physician may order imaging tests to further investigate the condition.

Imaging Tests for Degenerative Spondylolisthesis

X-rays are helpful in diagnosing and assessing the extent of degenerative spondylolisthesis.

Imaging tests may help confirm the diagnosis of degenerative spondylolisthesis and provide evidence of the extent of progression of the condition. 

• Standing lateral radiographs are considered the most reliable and standard test for diagnosing degenerative spondylolisthesis. 7 Akkawi I, Zmerly H. Degenerative Spondylolisthesis: A Narrative Review. Acta Biomed. 2022;92(6):e2021313. Published 2022 Jan 19. doi:10.23750/abm.v92i6.10526
• Flexion-extension radiographs are used to determine if there is any motion of one vertebra upon the other (translation) and/or instability during spinal movements. 7 Akkawi I, Zmerly H. Degenerative Spondylolisthesis: A Narrative Review. Acta Biomed. 2022;92(6):e2021313. Published 2022 Jan 19. doi:10.23750/abm.v92i6.10526
• Magnetic resonance imaging (MRI) scans may be used to check for spinal stenosis, nerve root compression, spinal cord involvement, and disc degeneration. 3 García-Ramos CL, Valenzuela-González J, Baeza-Álvarez VB, Rosales-Olivarez LM, Alpizar-Aguirre A, Reyes-Sánchez A. Degenerative spondylolisthesis I: general principles. Espondilolistesis degenerativa lumbar I: principios generales. Acta Ortop Mex. 2020;34(5):324-328.. , 7 Akkawi I, Zmerly H. Degenerative Spondylolisthesis: A Narrative Review. Acta Biomed. 2022;92(6):e2021313. Published 2022 Jan 19. doi:10.23750/abm.v92i6.10526  Some researchers consider MRI scans as the most reliable test to diagnose spinal stenosis in degenerative lumbar spondylolisthesis. 8 Matz PG, Meagher RJ, Lamer T, et al. North American Spine Society. Clinical Guidelines for Multidisciplinary Spine Care. Diagnosis and Treatment of Degenerative Lumbar Spondylolisthesis. 2nd ed.; 2016.
• CT scans are used if bone involvement such as spondylolysis or isthmic spondylolisthesis is suspected, as these scans provide detailed evaluation of bone integrity.

If an MRI is not possible, computed tomography (CT) scans with myelography may be used as an alternative test. 7 Akkawi I, Zmerly H. Degenerative Spondylolisthesis: A Narrative Review. Acta Biomed. 2022;92(6):e2021313. Published 2022 Jan 19. doi:10.23750/abm.v92i6.10526 , 8 Matz PG, Meagher RJ, Lamer T, et al. North American Spine Society. Clinical Guidelines for Multidisciplinary Spine Care. Diagnosis and Treatment of Degenerative Lumbar Spondylolisthesis. 2nd ed.; 2016.

MRI scans or CT scans may also be used if severe neurogenic claudication is present, bowel and/or bladder incontinence is reported, and/or tumors are suspected. 

• 1 Cushnie D, Johnstone R, Urquhart JC, Gurr KR, Bailey SI, Bailey CS. Quality of Life and Slip Progression in Degenerative Spondylolisthesis Treated Nonoperatively. Spine (Phila Pa 1976). 2018;43(10):E574-E579. doi: 10.1097/BRS.0000000000002429
• 2 Li N, Scofield J, Mangham P, Cooper J, Sherman W, Kaye A. Spondylolisthesis. Orthop Rev (Pavia). 2022 Jul 27;14(4):36917. doi: 10.52965/001c.36917 . PMID: 35910544; PMCID: PMC9329062.
• 3 García-Ramos CL, Valenzuela-González J, Baeza-Álvarez VB, Rosales-Olivarez LM, Alpizar-Aguirre A, Reyes-Sánchez A. Degenerative spondylolisthesis I: general principles. Espondilolistesis degenerativa lumbar I: principios generales. Acta Ortop Mex. 2020;34(5):324-328..
• 4 Wang YXJ, Káplár Z, Deng M, Leung JCS. Lumbar degenerative spondylolisthesis epidemiology: A systematic review with a focus on gender-specific and age-specific prevalence. J Orthop Translat. 2016;11:39-52. Published 2016 Dec 1. doi: 10.1016/j.jot.2016.11.001
• 5 Kalichman L, Hunter DJ. Diagnosis and conservative management of degenerative lumbar spondylolisthesis. Eur Spine J. 2008;17(3):327-335. doi: 10.1007/s00586-007-0543-3
• 6 Studnicka K, Ampat G. Lumbosacral Spondylolisthesis. [Updated 2022 Sep 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560679/
• 7 Akkawi I, Zmerly H. Degenerative Spondylolisthesis: A Narrative Review. Acta Biomed. 2022;92(6):e2021313. Published 2022 Jan 19. doi: 10.23750/abm.v92i6.10526
• 8 Matz PG, Meagher RJ, Lamer T, et al. North American Spine Society. Clinical Guidelines for Multidisciplinary Spine Care. Diagnosis and Treatment of Degenerative Lumbar Spondylolisthesis. 2nd ed.; 2016.

Dr. Marco Funiciello is a physiatrist with Princeton Spine and Joint Center. He has a decade of clinical experience caring for spine and muscle conditions with non-surgical treatments.

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Spondylolisthesis

Persistent back pain and numbness down your legs may be caused by spondylolisthesis, where one of the bones in your spine has slipped out of position.

By Wallace Health I Medically reviewed by Adrian Roberts. Page last reviewed: October 2018 I Next review due: October 2023

What is spondylolisthesis?

This usually occurs in your lower back but can also occur in your neck or mid to upper back. A slipped vertebra can put pressure on the nerves in your spinal canal, which connect your brain and your body. This can cause pain, pinching, numbness and weakness, usually in your lower back and legs. 

Spondylolisthesis is not the same as a slipped disc — a slipped disc refers to one of the fluid-filled cushions between your vertebrae slipping out of position.

Spondylolisthesis is pronounced spohn-di-low-less-THEE-sis. In Greek, spondylos means spine or vertebra and listhesis means movement, sliding or slipping.

Is spondylolisthesis the same as spondylolysis?

Spondylolysis and spondylolisthesis both cause lower back pain but they are not the same condition. 

Spondylolysis is caused by a bone defect in your spine, which is usually caused by a stress fracture. It is common in young athletes.

Spondylolisthesis is caused by a vertebra slipping out of place and putting pressure on the vertebra below it as well as the nerves that run through the spinal canal. 

However, spondylolysis can cause spondylolisthesis if the stress fracture results in the vertebra slipping.

How to tell if you have spondylolisthesis

Spondylolisthesis is most common in your lower back and might cause these symptoms:

• Lower back pain which may get worse during activity
• Pain, numbness or pins and needles down your legs (these symptoms are known as sciatica )
• Tight hamstrings
• Curvature or bulging of the spine

If you have difficulty walking and feel unsteady on your feet, this may also be a sign.

It's possible to have spondylolisthesis without any of these symptoms.

Talk to your doctor if you’re concerned about symptoms

You can book an appointment  with a Spire private GP today.

Book an appointment

Diagnosis and tests for spondylolisthesis

You should see your GP if: 

• You have persistent back pain or stiffness
• You have persistent pain in your buttocks or thighs
• Your back curves outwards

Your GP may examine your back, although spondylolisthesis doesn’t usually cause any visible symptoms. They may also examine your limbs to see the amount of movement and pain you have. This may include a straight leg test — this involves lying on your back while your GP holds your foot and gently lifts your leg up while you keep your knee straight.

You may need an X-ray while standing to see if you have a slipped vertebra in your spine or a spinal fracture. If you have numbness, weakness or tingling in your legs, you may also need an MRI scan or CT scan to detect if your slipped vertebra is compressing a nerve.

Causes of spondylolisthesis

There are different causes of spondylolisthesis:

• A birth defect in a vertebra — this can cause the vertebra to slip forward 
• A sudden injury, such as a fracture from a car accident
• An infection or tumour that causes a bone abnormality
• Gradual wear and tear of the vertebrae and cartilage ( osteoarthritis ) — this is more common in older people
• Repetitive trauma, such as heavy weight lifting or gymnastics, which causes a defect in your spine to develop
• Spinal stenosis

Types of spondylolisthesis

The three most common types of spondylolisthesis are:

• Congenital spondylolisthesis — a defect in the formation of a baby's spine before birth that increases the risk of a vertebra slipping in later life
• Degenerative spondylolisthesis — the most common type of spondylolisthesis caused by thinning of the vertebral discs (fluid-filled cushions that sit between the vertebrae) as you get older; the discs thin because they lose water and thinner discs increase the chance of a vertebra slipping out of place
• Isthmic spondylolisthesis — caused by spondylolysis ie a defect of the spine usually caused by a stress fracture

Less common types of spondylolisthesis include:

• Pathological spondylolisthesis — caused by a disease (eg osteoporosis) or a tumour
• Post-surgical spondylolisthesis — caused by spinal surgery 
• Traumatic spondylolisthesis — caused by an injury to the spine

Who is at risk of spondylolisthesis?

Your risk of developing spondylolisthesis is greater if: 

• You are a young athlete — children and teenagers who play sports that stretch the lower spine eg football or gymnastics; spondylolisthesis usually occurs during a growth spurt and is the most common cause of back pain in teenagers
• You are aged over 50 — degenerative spondylolisthesis is more likely as you get older as it is caused by wear and tear of the spine over time, although it also has a genetic component
• You are born with part of your vertebra called the pars interarticularis being thinner than normal — the pars interarticularis connects the facet joints which link a vertebra to the vertebrae above and below it so your spine can function as a unit; a thinner pars interarticularis is more likely to fracture and cause the vertebra to slip
• You have another degenerative spinal condition

Common treatments for spondylolisthesis

The treatment you receive will depend on the severity of your symptoms and how much they are affecting your quality of life. In most cases, your doctor will recommend non-surgical treatments first, such as: 

• Anti-inflammatory painkillers eg ibuprofen — if over-the-counter medications are not enough to reduce your pain, your doctor may prescribe stronger painkillers
• Bracing — usually only for children
• Steroid injections to relieve inflammation and pain — this includes: 
• Facet joint injections  
• Injections around the nerve that is being compressed by the slipped vertebra
• Physiotherapy — targeted daily exercises to stretch and strengthen your abdomen, hamstrings and lower back; this will help reduce your pain and increase your range of motion
• Rest — avoiding activities, such as bending, lifting, athletics and other sports, for a short period of time

These treatments provide temporary relief and during this time, your symptoms may go away on their own. 

Your doctor will usually only recommend back surgery if:

• A nerve is compressed
• Non-surgical treatments have not worked
• Your symptoms are persistent and severe

The type of back surgery you have will depend on what type of spondylolisthesis you have. This could be: 

• Decompression surgery to remove part of your spine to relieve pressure
• Surgery to fuse the slipped vertebra to the vertebrae next to it using metal rods and screws and a piece of your own bone — this will keep the slipped vertebra in place
• Surgery to remove the vertebral disc between two vertebrae and replace it with a metal cage containing a bone graft — this will hold the vertebrae apart

These are major surgeries and you will need to stay in hospital for up to a week. It will take months for a full recovery.  

Surgery usually relieves many spondylolisthesis symptoms, including pain and numbness in the legs. However, there are risks of complications, including: 

• Damage to the spinal nerves or spinal cord — this can cause ongoing symptoms of numbness or weakness in the legs and in rare cases, bowel incontinence , urinary incontinence or paralysis
• Deep vein thrombosis (DVT) — a blood clot in one of the deep veins in your leg 
• Infection at the surgical site 

Your doctor or surgeon will discuss the details of your surgical options and the risks involved before you make a decision. 

Will spondylolisthesis come back?

In most cases, pain caused by spondylolisthesis goes away after recovering from spondylolisthesis surgery. Over time, you can return to your normal activities and regain full function and movement.

Spondylolisthesis complications

Spondylolisthesis can cause cauda equina syndrome. At the base of your spinal cord is a collection of nerves called the cauda equina. In cauda equina syndrome, these nerves are compressed, which can cause loss of feeling in your legs and bladder problems. It is a medical emergency. If it is not treated it can cause urinary incontinence and paralysis.

How can I reduce my risk of spondylolisthesis?

• Eat a healthy, balanced diet to maintain strong bones
• Maintain a healthy weight — being overweight or obese puts extra strain on your spine
• Perform regular exercises to strengthen your back and abdomen

Spondylolisthesis outlook

In some cases, spondylolisthesis comes back but this is usually if your first instance of spondylolisthesis was severe ie your vertebra moved considerably out of its normal position. 

However, after spondylolisthesis surgery, most people return to normal activities after a recovery period, although your spine will be less flexible.

Frequently asked questions

How do you fix spondylolisthesis?

Spondylolisthesis can be treated without surgery by using anti-inflammatory painkillers, physiotherapy and with rest. In some cases, you may need steroid injections. However, if these treatments are not effective, back surgery may be recommended.

Is spondylolisthesis serious?

Spondylolisthesis can be mild, moderate or severe. Severe cases of spondylolisthesis can be serious as they may lead to cauda equina syndrome, which is a medical emergency — if this condition is not treated it can cause urinary incontinence and paralysis. Even moderate cases, over time, if left untreated, can cause nerve damage if a nerve is compressed. You should therefore see your GP if you are concerned that you have spondylolisthesis as there are effective treatments.

What is the difference between spondylolysis and spondylolisthesis?

Both conditions can cause lower back pain. However, the underlying cause is different. Spondylolisthesis is caused by a bone in your spine (vertebra) slipping out of place, whereas spondylolysis is caused by a defect in your vertebra, which is usually caused by a stress fracture.

Is walking bad for spondylolisthesis?

Walking is not bad for spondylolisthesis as long as it doesn’t worsen your pain. Walking and other exercises that do not bend or strain your back can help strengthen your back and abdominal muscles, which can reduce your pain and improve your range of motion.

Can chiropractic help spondylolisthesis?

A chiropractor can’t fix your spondylolisthesis — they can’t push the slipped vertebra back into place. However, they can improve your range of movement and reduce your pain by focusing on the rest of your spine.

What should you not do with spondylolisthesis?

You should not take part in activities that strain or stretch your back, such as athletics, bending, lifting and football.

Can you become paralyzed from spondylolisthesis?

If a nerve is compressed, over time, spondylolisthesis can cause nerve damage, which may lead to paralysis. In some cases, spondylolisthesis can cause cauda equina syndrome — another spinal condition that is a medical emergency because if it is left untreated there is a high risk of paralysis.

Can you live with spondylolisthesis without surgery?

Yes, in many cases, spondylolisthesis can be effectively treated with non-surgical interventions, such as physiotherapy, resting your back, taking painkillers and/or steroid injections.

How should I sleep with spondylolisthesis?

Sleeping on your back in a reclining position can help reduce the pressure on your spine caused by the slipped vertebra ie sleeping propped up on several pillows.

When should you have surgery for spondylolisthesis?

If you have tried non-surgical treatments for spondylolisthesis (rest, physiotherapy, painkillers and steroid injections) and they have not worked, then surgery may be recommended. Your doctor may also recommend surgery if a nerve is compressed or your symptoms are persistent and severe.

Can you live a normal life after spinal fusion?

After a period of recovery, you can return to your normal activities. However, you will have reduced flexibility in the area of your spine where the vertebrae were fused.

Can spondylolisthesis cause bowel problems?

If spondylolisthesis is causing severe compression of a nerve, this can cause bowel incontinence.

Does spondylolisthesis get worse over time?

This depends on the severity and type of spondylolisthesis you have. Over time, symptoms of mild spondylolisthesis may go away on their own. However, in other cases, symptoms can get worse eg if a nerve is compressed or if you have degenerative spondylolisthesis.

https://www.nhs.uk/conditions/spondylolisthesis/

http://www.britscoliosissoc.org.uk/patient-information/spondylolisthesis  

https://orthoinfo.aaos.org/en/diseases--conditions/spondylolysis-and-spondylolisthesis/  

https://my.clevelandclinic.org/health/diseases/10302-spondylolisthesis  

https://www.webmd.com/back-pain/guide/pain-management-spondylolisthesis

https://patient.info/doctor/spondylolysis-and-spondylolisthesis

https://spinalresearch.com.au/6735-2/

https://www.healthline.com/health/healthy-sleep/best-sleeping-position-for-lower-back-pain

Related topics

Related treatments:

• Back surgery (spinal surgery)
• Facet joint injections
• Physiotherapy from Spire

Related symptoms:

Related conditions:

Professional Faqs: What Can I Do To Prevent Spondylolisthesis From Getting Worse?

Expert opinion from marcella abunahman pereira, specialization in clinical cardiology · 12 years of experience · brazil.

Spondylolisthesis is a spinal condition that causes back pain . It occurs when one of your vertebrae, the bones of your spine, slips out of place onto the vertebra below it. It can occur anywhere in the spine but is most common in the lower back. To prevent it, you should do regular exercises to strengthen your back and abdominal muscles. Also maintain a healthy weight because excess weight puts added stress on your back, quit smoking and eat a well-balanced diet to keep your bones strong.

Expert opinion from Rajesh Mishra

Mbbs · less than a year of experience · india.

Step 1: Lie on your back with your knees bent and your feet flat on the floor. Step 2: Pull your belly button in toward your spine using your abdominal muscles and flatten your lower back onto the floor. Step 3: Keeping your core muscles engaged, hold the position for 15 seconds. And then relax.

→ Learn more about spondylolisthesis: See the causes, symptoms, treatment options and more.

→ See more questions and expert answers related to spondylolisthesis.

Expert opinion from Ilya Aleksandrovskiy

M.d., mba · 5 years of experience · usa.

You can prevent spondylolisthesis from getting worsen by: *Do exercise for strong back and abdominal muscles. *Maintain healthy-weight. *Eat healthy and balanced diet to nourish your bone.

Disclaimer: This is for information purpose only, and should not be considered as a substitute for medical expertise. These are opinions from an external panel of individual doctors, and not to be considered as opinion of Microsoft. Please seek professional help regarding any health conditions or concerns.

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