What is spondylolisthesis?

Spondylolisthesis is a condition involving spine instability, which means the vertebrae move more than they should. A vertebra slips out of place onto the vertebra below. It may put pressure on a nerve, which could cause lower back pain or leg pain.

Spondylolysis may cause spondylolisthesis when a stress fracture causes the slipping. Or the vertebra may slip out of place due to a degenerative condition. The disks between vertebrae and the facet joints (the two back parts of each vertebrae that link the vertebrae together) can wear down. Bone of the facet joints actually grows back and overgrows, causing an uneven and unstable surface area, which makes the vertebrae less able to stay in place. No matter what the cause, when the vertebra slips out of place, it puts pressure on the bone below it. Most cases of spondylolisthesis do not cause symptoms. If you feel leg pain, it can also be caused by compression or a "pinching" of the nerve roots that exit the spinal canal (the tunnel created by the interlocking vertebrae of the spine). The compression or pinching is due to the vertebrae slipping out of position and narrowing the needed space for the nerves.

 

Degenerative spondylolisthesis, the most common type, happens due to aging. Over time, the disks that cushion the vertebrae lose water. As the disks thin, they are more likely to slip out of place.

Spondylolisthesis and spondylolysis occur in about 4% to 6% of the adult population. It’s possible to live with spondylolisthesis for years and not know it, since you may not have symptoms.Degenerative spondylolisthesis (which occurs due to aging and wear and tear on the spine), is more common after age 50 and more common in women than men.

 

When back pain occurs in teens, isthmic spondylolisthesis (usually caused by spondylolysis) is one of the most common causes.

 

Who is at risk for spondylolisthesis?

You may be more likely to develop spondylolisthesis due to:

 

Athletics: Young athletes (children and teens) who participate in sports that stretch the lumbar spine, such as gymnastics and football, are more likely to develop spondylolisthesis. The vertebra slippage tends to occur during children’s growth spurts. Spondylolisthesis is one of the most common reasons for back pain in teens.

Low-grade (Grade I and Grade II) typically don’t require surgery. Low grade cases are usually seen in adolescents with isthmic spondylolisthesis and in almost all cases of degenerative spondylolisthesis.

High-grade (Grade III and Grade IV) may require surgery if you’re in a lot of pain.

Will I need surgery for spondylolisthesis?

Your healthcare provider will start with nonsurgical options, such as rest and physical therapy. These treatments often relieve symptoms. Your healthcare provider may recommend surgery if you:

 

Experience severe pain.

Tried nonsurgical treatments but still have symptoms.

Symptoms and Causes

What causes spondylolisthesis?

Overextending the spine is one of the main causes of spondylolisthesis in young athletes. Genetics may play a role, too. Some people are born with thinner vertebral bone. In older adults, wear and tear on the spine and disks (the cushions between vertebrae) can cause this condition.

 

What are the symptoms of spondylolisthesis?

You may not experience any symptoms of spondylolisthesis. Some people have the condition and don’t even know it. If you do have symptoms, lower back pain is typically the main one. The pain may extend to the buttocks and down the thighs. You may also experience:

 

Muscle spasms in the hamstring (muscles in the back of the thighs).

Back stiffness.

Difficulty walking or standing for long periods.

Pain when bending over.

Numbness, weakness or tingling in the foot.

Diagnosis and Tests

How is spondylolisthesis diagnosed?

Your healthcare provider will do a physical exam and ask you about your symptoms. You will then likely need an imaging scan to confirm the diagnosis.

 

What imaging tests will I need?

Spinal X-ray helps healthcare providers see if a vertebra is out of place.

CT scan or MRI scan may be necessary to see the spine in more detail or to see soft tissue such as discs and nerves.

Management and Treatment

How do healthcare providers treat spondylolisthesis?

Treatment depends on the grade of the slippage, your symptoms, age and overall health. Your healthcare provider will discuss treatment options with you. You may need medication, physical therapy or surgery.

 

What nonsurgical treatments are available for spondylolisthesis?

Nonsurgical treatments include:

 

Rest: Take a break from strenuous activities and sports.

Medication: An over-the-counter nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen (Motrin®) or naproxen (Aleve®), can bring relief. If those don’t work, your healthcare provider may prescribe other medications.

Injections: You receive an injection of steroid medications directly into the affected area.

Physical therapy: A physical therapist can teach you targeted exercises to strengthen your abdomen (belly) and back. Daily exercises often relieve pain after a few weeks.

Bracing: A brace can help stabilize your spine. The brace limits movement so that fractures can heal. Braces are not used in adults.

How do I know if I need surgery for spondylolisthesis?

You may need surgery if you have high-grade spondylolisthesis, the pain is severe or you’ve tried nonsurgical treatments without success. The goals of spondylolisthesis surgery are to:

 

Relieve pain from the irritated nerve.

Stabilize the spine where the vertebra has slipped.

Restore your function.

What happens during surgery for spondylolisthesis?

Surgery for back pain due to spondylolisthesis typically involves spinal decompression, with or without fusion. Decompression alone is almost never done in isthmic spondylolisthesis. Studies show fusion with decompression may give better outcome than decompression alone. During a decompression surgery, your surgeon removes bone and disk from the spine. This procedure gives the nerves space inside the spinal canal, relieving pain.

 

For a fusion surgery, your surgeon fuses (connects) the two affected vertebrae. As they heal, they form into one bone, eliminating movement between the two vertebrae. You may experience some limited spinal flexibility as a result of the surgery.

 

Will spondylolisthesis come back?

Most of the time, pain is gone after you recover from spondylolisthesis surgery. You can gradually begin to resume your activities until you are back to full function.

Surgery has a high success rate. People who have surgery for spondylolisthesis often return to an active life within a few months of surgery. You will likely need rehabilitation after surgery to help you get back to full function.

 

Living With Spondylolisthesis

While the condition won’t go away on its own, you can often experience relief through rest, medication and physical therapy.

Nonsurgical treatments cannot undo the crack or slippage, but they can provide long-term pain relief. Surgery can relieve pressure on the nerves, stabilize the vertebrae and restore your spine’s strength.