What is spondylolisthesis?

Spondylolisthesis is the slippage of one vertebra from the normal position in your spine. It stresses the vertebra below it, creating a condition where spondylolisthesis can occur. Spondylolisthesis is pronounced spohn-di-low-less-THEE-sis.

Your spine comprises 33 stacked bones called vertebrae- the plural form of the vertebra. Your vertebrae are attached together but allow for a little movement as you move your body or posture.

If you have spondylolisthesis, your extra movement can cause more than your vertebra to move and slide out of its usual place to nest on top of the vertebra below it. In many cases, this places pressure on nearby nerves near the spine, which leads to back pain and other symptoms.

Spondylolisthesis can occur anywhere in the spine, but the most common location is in the lower back along the lumbar spine. It can also be present in the neck, the cervical spine, or the middle back, which starts at the bottom of your neck and then just below your ribs, known as the thoracic spine.

The vertebrae forming your backbone are the chain links that always support you. It might be intimidating to think about one of these links that fall out of alignment, but that doesn't necessarily mean the whole chain is at risk. Spondylolisthesis tends to be very responsive to treatment. See a healthcare provider if you experience any new pain in your back, legs, or elsewhere, causing you difficulty moving around throughout your day.

What are the symptoms of spondylolisthesis?

Some people have spondylolisthesis and never have any symptoms. Extremely minor (low-grade) slippage may not cause enough stress on the rest of your spine or your nerves to cause symptoms.

If you do have symptoms, they can include:

Pain in your lower back.
Sciatica (pain in your legs).
Stiffness in your back.
Trouble standing or walking for longer than a few minutes without becoming symptomatic.
Numbness, weakness, or tingling in your feet.
Depending on the area where your vertebra is being slipped out of place, you might feel pain in other parts of your back, too. The pain could run down to your buttocks or thighs.

What causes spondylolisthesis?

What can cause a vertebral slip of position depends significantly on the type you suffer from. Most spondylolisthesis cases result from one of the following:

Normal aging and wear in your spinal disks.
They are born with naturally thinner vertebrae than others.
Sports injuries.
Growth spurts (in children and adolescents).
Traumas like a fall or a car accident.

What are the risk factors?

Anyone can set spondylolisthesis, but some people are at more risk; among them are:

Older than 50.
People assigned female at birth (AFAB).
Athletes especially in contact sports or who jump or stretch often.
People have a biological family history of spondylolisthesis or bone health conditions.

What are the complications of spondylolisthesis?

If spondylolisthesis is not diagnosed and treated, you are at risk of the following:

Chronic pain in your back.
Spinal arthritis.
Nerve damage.
You can't hold your pee (urinary incontinence), or you can't have your poop (bowel incontinence).

How is the diagnosis for spondylolisthesis done?

A healthcare provider uses a physical exam and imaging tests to diagnose spondylolisthesis. They check your back and spine.

Let your provider know when you first felt the pain or other symptoms and if certain activities or movements worsened them. Your provider wants to know what you were doing before the onset of the symptoms, especially if you remember that you had some injury.

The doctor will take a spine X-ray to send pictures of your vertebrae. You might also require a CT scan or MRI to determine if you have injured the disk or nerves.

Spondylolisthesis Grades:

There are various classifications for spondylolisthesis, and they are generally classified in the following categories:

Your physician will grade the spondylolisthesis to give you an understanding of how far out of place your vertebra slid. They may accomplish this using a number grade or just refer to it as low grade or high grade.

Low-grade spondylolisthesis (Grade I and Grade II): Low-grade spondylolisthesis is the most common type. Most teenagers with isthmic spondylolisthesis and adults with degenerative spondylolisthesis have low-grade cases.
High-grade spondylolisthesis (Grade III and Grade IV): High-grade cases are much more likely to be treated with surgery, particularly if you have significant pain or other symptoms.

What are the treatments for spondylolisthesis?

For most individuals with spondylolisthesis, their symptoms can be managed with nonsurgical treatments, including:

Rest: Avoiding sports and other strenuous activities reduces the stress on your spine.
Over-the-counter (OTC) NSAIDs or acetaminophen may help reduce your pain and inflammation. Do not use OTC pain medicines for more than 10 days in a row without first consulting your provider. Ask your provider before using any at-home medications; they will know which ones are safe.
Corticosteroids: Corticosteroids are anti-inflammatory medications prescribed by your physician. Your physician may prescribe oral medication to be taken orally. The corticosteroid injection might be directly injected into the affected area.
Physical therapy: A physical therapist will give you exercises that will help strengthen the muscles around your spine, specifically your back muscles and core—the muscles of your abdomen. This will relieve the pressure off the discs in your spine, and you will start moving a lot better.
Bracing: In the case of a fractured vertebra, your doctor may recommend you wear a back brace to stabilize your spine. Your doctor will explain for how long you must wear a brace.

When is surgery needed with spondylolisthesis?

Not everyone who has spondylolisthesis needs surgery to correct the condition. If the out-of-place vertebra does not cause significant symptoms or increase your chances of complications, you might be able to live with a low-grade slippage in your slipped vertebra.

The provider can suggest when it is probably time to have surgery. You will probably require surgery if the following are true:

You have high-grade spondylolisthesis.
You cannot control your pain or other symptoms, and you are unable to stand, walk, or move.
Other treatments apart from surgery have not alleviated your symptoms.
Typically, you will have a spinal fusion procedure wherein the positions of your vertebrae are corrected, and the surrounding areas will be strengthened. If the pressure caused by the spondylolisthesis is significant, then you will also undergo a procedure known as a spinal decompression, wherein the compression on your sciatic nerve is relieved.
Your provider or surgeon will inform you which surgery you need and what to expect.

What are the side effects of surgery for spondylolisthesis?

Some patients who undergo spinal fusion will be left with a reduced range of motion or flexibility in the back. During spinal fusion, the two vertebrae will meld into one bone. In most cases, most patients are willing to make that tradeoff, as they will have much less pain. Do not hesitate to talk to your surgeon before you decide on surgery. He will help you understand what the risks are and set realistic goals.

Can I prevent spondylolisthesis?

You may not always be able to prevent spondylolisthesis, mainly because sudden injuries or how your spine forms can cause it. But you can lower your risk with these tips:

Do physical activities that strengthen your back and abdominal muscles.

Follow an eating plan that's healthy for you. This can help protect your bones and overall health.

Discuss your bone health with your provider. They can advise you when to have bone density tests regularly.

What can I expect if I have spondylolisthesis?

If you have spondylolisthesis, nonsurgical treatments, including rest, medication, and physical therapy, should improve your symptoms. Your provider will take additional X-rays as you begin treatment to check if your vertebra moves further out of alignment. They will monitor the out-of-place vertebra. If it becomes unstable, you may need surgery.

Nonsurgical treatments cannot reduce the displaced vertebra but may permit you to return to your daily activities free of pain. You can only regain the normal alignment of your spine with surgery.

How long does it take for you to make a complete recovery after spinal surgery?

It may range from several weeks to months. Your surgeon who operated on you will give you a personalized recovery schedule depending on your condition.

What can you not do if you have spondylolisthesis?

Your healthcare provider will advise you which activities are safe. You may need to avoid contact sports or high-impact activities that elongate or stress your spine significantly.

Living With

When should I see my healthcare provider?

The sooner you see a healthcare provider, the sooner they can make a diagnosis and start spondylolisthesis treatment. See a provider as soon as you feel your back is hurting for more than a few days or when you are having pain that is persistent enough to keep you from doing what you usually do.