Spondylolisthesis

When one of the bones in your spine slips out of place and presses on the bone below it, it can cause pain and limit your daily activities. This condition, known as spondylolisthesis, affects thousands of people each year, but many cases can be successfully managed with the right treatment approach.

Table of contents

• What is Spondylolisthesis?
• Types of Spondylolisthesis
• Symptoms
• Causes and Risk Factors
• Diagnosis
• Treatment Options
• Outlook and Living With the Condition

What is Spondylolisthesis?

Spondylolisthesis happens when one of the vertebrae (the bones that make up your spine) slips out of its normal position and moves forward onto the vertebra below it.^[1] The word comes from Greek: “spondylo” means spine, and “listhesis” means to slip or slide.^[6]

Your spine is made of 33 stacked bones called vertebrae. These bones are connected together but can move a little bit as you move your body and change your posture. If you have spondylolisthesis, one of your vertebrae moves more than it should and slides out of its usual spot.^[1] This can put pressure on nerves around your spine and cause back pain and other symptoms.

Spondylolisthesis can happen anywhere in your spine, but it most commonly occurs in your lower back, known as the lumbar spine.^[1] The condition can also affect your neck (cervical spine) or your midback area from the bottom of your neck to just below your ribs (thoracic spine).^[1]

The severity of spondylolisthesis is measured using a grading system based on how far the vertebra has slipped. Grade I represents minor slippage of 1% to 25%, while Grade V indicates severe displacement of more than 100%.^[7] Grades I and II are considered low grade.^[7]

Types of Spondylolisthesis

There are several different types of spondylolisthesis, each with its own underlying cause.^[1]

Degenerative spondylolisthesis is the most common type. It happens as your body naturally ages and the disks that cushion the spaces between your vertebrae break down or degenerate. As the disks thin, there is more space between your vertebrae, which increases the risk that one slips out of place.^[1] This type is more common in women and in people over the age of 50.^[13] A higher incidence has been noted in the African-American population than in other populations.^[13]

Isthmic spondylolisthesis happens when the bone that connects two vertebrae together (the pars interarticularis) breaks and cannot hold its usual alignment. That fractured vertebra then slips out of place.^[1] This type can occur in young athletes who participate in sports that involve repeated stress on the lower back, such as gymnastics, football, and weightlifting.^[3]

Congenital spondylolisthesis, also called dysplastic spondylolisthesis, happens when a baby’s spine doesn’t form the way it should before they are born. The misaligned vertebrae can cause issues right away or much later in life.^[1]

Less common types include traumatic spondylolisthesis, which occurs when an injury or accident puts enough force on your spine to push a vertebra out of place.^[1] Pathological spondylolisthesis is caused by conditions that weaken your bones, like osteoporosis or a tumor.^[1] Finally, postsurgical spondylolisthesis is rare but can be a side effect of having spinal surgery.^[1]

Symptoms

Some people have spondylolisthesis and never experience any symptoms. Very minor (low-grade) slippage may not put enough pressure on the rest of your spine or nerves to cause any symptoms.^[1] However, when symptoms do occur, they can range from mild discomfort to severe pain.^[6]

The main symptoms of spondylolisthesis include:

• Lower back pain, often worse when standing or walking and relieved when sitting or bending forward^[4]
• Back stiffness^[1]
• Difficulty walking or standing for more than a few minutes at a time^[1]
• Pain spreading to your bottom or thighs^[4]
• Tight hamstrings (the muscles in the back of your thighs)^[4]
• Sciatica (pain in your legs)^[1]
• Numbness, weakness, or tingling in your feet^[1]
• Pain, numbness, or tingling spreading from your lower back down one leg^[4]

You might feel pain in other areas of your back, depending on where in your spine the vertebra slips out of place. The pain might spread (radiate) into your buttocks or thighs.^[1]

Causes and Risk Factors

Spondylolisthesis can develop for several reasons. The condition can happen as you get older – the bones of the spine can weaken with age.^[4] As people age, general wear and tear causes changes in the spine. The disks in the spine lose height, become stiff, and begin to dry out, weaken, and bulge. As these disks lose height, the ligaments and joints that hold vertebrae in proper position begin to weaken. In some people, this can create instability and ultimately result in degenerative spondylolisthesis.^[13]

Repeated stress on the spine, especially in young athletes, can cause tiny fractures in the vertebrae. Over time, these fractures can weaken the bone and allow slippage.^[7] This is particularly common in sports that involve repeated overextension of the lower back, like gymnastics, football, and weightlifting.^[3]

Spondylolisthesis can run in families.^[4] Some individuals are born with a defect in the spine that predisposes them to vertebral slippage.^[7]

Other causes include a sudden injury such as a car accident or fall that may damage the spine and lead to vertebral slippage, or conditions like osteoporosis or tumors that weaken the bones.^[6]

Diagnosis

If you have symptoms of spondylolisthesis, a doctor may examine your back.^[4] They may also ask you to lie down and raise one leg straight up in the air. This is painful if you have tight hamstrings or sciatica caused by spondylolisthesis.^[4]

To accurately diagnose spondylolisthesis in the spine, you will need specific imaging tests. The doctor may arrange an X-ray to see if a bone in your spine has slipped forward.^[4] You may have other scans, such as an MRI scan, if you have pain, numbness, or weakness in your legs.^[4] It is important to get an accurate diagnosis and to correlate your symptoms with the test results.^[16]

Treatment Options

Many people can manage symptoms like pain and stiffness without surgery.^[1] Treatments for spondylolisthesis depend on the symptoms you have and how severe they are.^[4]

Nonsurgical Treatments

Nonsurgical treatment is the first-line approach for most patients with spondylolisthesis, focusing on symptom relief and functional improvement.^[2] Common treatments include:

• Avoiding activities that make symptoms worse, such as bending, lifting, athletics, and gymnastics^[4]
• Taking anti-inflammatory painkillers such as ibuprofen or stronger painkillers on prescription^[4]
• Steroid injections in your back to relieve pain, numbness, and tingling in your leg^[4]
• Physiotherapy to strengthen and stretch the muscles in your lower back, tummy, and legs^[4]
• Bracing that immobilizes the spine for short periods of time^[5]

Regular exercise, including a mixture of cardiovascular exercise and strength training, can help strengthen the muscles and connective tissue that support the spine. This in turn decreases stress on the vertebrae, discs, and joints, which can potentially slow the degeneration that can lead to vertebral slippage.^[17]

Surgical Treatment

Your doctor will suggest surgical repair if the slip is a high grade or nonsurgical treatments don’t help.^[1] Surgery is reserved for cases where conservative treatments fail or when progressive neurological deficits or deformities occur.^[2]

Types of surgery include:

• Spinal fusion – the slipped bone (vertebra) is joined to the bone below with metal rods, screws, and a bone graft^[4]
• Lumbar decompression – a procedure to relieve pressure on the compressed spinal nerves^[4]

The operation is done under general anesthetic, which means you will not be awake. Recovery from surgery can take several weeks, but it often improves many of the symptoms of spondylolisthesis.^[4] Surgery combining a decompressive laminectomy with a spinal fusion is rarely needed for spondylolisthesis symptoms that are not healing or have neurological components.^[5]

Outlook and Living With the Condition

The vertebrae in your spine are links in a chain that constantly support you. It might sound scary to think about one of those links falling out of alignment, but that doesn’t mean the whole chain is in trouble. Spondylolisthesis usually responds very well to treatment.^[1]

Most cases of spondylolisthesis do not cause any symptoms. If patients have limited or no symptoms, it is typically not dangerous to leave spondylolisthesis untreated.^[12] Spondylolisthesis only becomes a concern when patients develop associated symptoms due to nerve compression, disc degeneration, or osteoarthritis.^[12]

You should visit a healthcare provider if you notice new pain in your back, legs, or anywhere else that’s making it hard to move throughout your day.^[1] You should see a doctor 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, or you have pain, numbness, and tingling down one leg for more than 3 or 4 weeks.^[4]

Most of the time you can manage this condition by maintaining a healthy, strong, and stable spine through exercise, maintaining a healthy body weight, watching your posture at work and while sleeping, and observing safe body mechanics when lifting and performing activities of daily living.^[16] Even something as simple as 20 minutes of walking, gentle stretching, and planking a few times a week can make a huge difference.^[17]

It isn’t possible to completely prevent spondylolisthesis from developing, as factors such as aging, genetics, and birth defects all contribute to this condition. However, the best thing anyone can do to prevent spondylolisthesis or prevent the condition from progressing is to take steps that increase overall spine health and slow down natural degeneration as much as possible.^[17]