Anterolisthesis: What You Need to Know

Medically Reviewed By Angela M. Bell, MD, FACP
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Anterolisthesis is a spine condition. It occurs when a vertebra slips forward out of place. This may or may not cause symptoms, such as low back pain or leg pain. Anterolisthesis can affect both children and adults. Several possible causes exist, from congenital conditions to wear and tear with age. Physical therapy is a common treatment.

This article reviews anterolisthesis, including its symptoms, causes, and treatment. It will also discuss the outlook for those with anterolisthesis.

What happens in anterolisthesis?

Gymnast doing handstand on balance beam
Jovo Jovanovic/Stocksy United

In anterolisthesis, a vertebra slips out of place, so it is forward relative to the one below it. This destabilizes the spine and may or may not cause symptoms.

Your spine consists of 24 vertebrae with discs in between them. Ligaments hold the vertebrae in alignment up and down the spine.

Anterolisthesis most commonly occurs in the lower back, or lumbar area of the spine.

Anterolisthesis vs. spondylolisthesis

Anterolisthesis is a type of spondylolisthesis. “Spondylo” refers to the vertebrae or spine, and “listhesis” relates to slippage. When a vertebra moves anteriorly (to the front), it is anterolisthesis. If it moves posteriorly (to the rear), it is retrolisthesis. Anterolisthesis is more common than retrolisthesis.

What are the symptoms of anterolisthesis?

The most common symptom of anterolisthesis is lower back pain. The pain may radiate down the buttocks and back of the thighs. Other symptoms can include:

Young people with anterolisthesis may not have any symptoms. In fact, doctors often find the condition incidentally in young people. It shows up on X-rays for some other condition or injury. Symptoms may not develop until adulthood. 

In both children and adults, symptoms are more likely with higher grades of anterolisthesis. Symptoms often worsen with activity and improve with rest. In particular, prolonged walking or standing may make symptoms worse. Bending forward, sitting, or laying down may relieve symptoms.

What causes anterolisthesis?

Anterolisthesis causes include:

  • unusual structure of the vertebrae present at birth
  • repetitive stress on the spine with activities and athletics
  • wear and tear of the spine with age
  • sudden injury, such as a fracture
  • disease, such as an infection or cancer

The most common causes are repetitive stress and age-related wear and tear of the spine.

How do doctors diagnose anterolisthesis?

To diagnose anterolisthesis, your doctor will take a medical history and perform an exam. Your doctor may ask you to bend forward, walk, or move in different ways. The goal is to see if certain movements generate pain or provide relief.

Your doctor may also order imaging exams, including:

  • X-rays, which may include X-ray images of your spine while you lean forward or backward
  • CT scan, which provides better imaging of bony details in the spine
  • MRI scan, which can help your doctor see soft tissues and nerves better than X-rays and CT scans

What does the grade of anterolisthesis mean?

Doctors grade anterolisthesis using X-ray images of the spine. The grade reflects the percentage of dislocation the vertebra has over the one below it, explains Merck Manual. The grades are as follows:

  • grade 1, 0–25% 
  • grade 2, 25–50%
  • grade 3, 50–75%
  • grade 4, 75–100%

About 75% of all cases are grade 1 slippages. When it is grade 1 or 2, there may be little or no pain. These two grades usually remain stable, but the slippage may progress in young people during puberty.

What treatments are available for anterolisthesis?

The goals of anterolisthesis treatment are to relieve symptoms and improve daily activities. Treatments can vary depending on the grade of slippage. First-line treatments include:

  • bracing
  • medications, including pain relievers and nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin)
  • physical therapy, which stretches and strengthens your core and lower back muscles to support your spine
  • rest, especially in case of overuse and repetitive stress on the spine
  • steroid injections into the spine to reduce pain and inflammation

Many people have success with these nonsurgical treatment options. Physical therapy can help treat low back pain without surgery. It can also help rehabilitate the low back during recovery after surgery if it becomes necessary.

Therapists will focus on lumbar stabilization exercises. With guidance from your physical therapist, these exercises include:

  • abdominal contractions or partial sit-ups
  • hamstring and hip stretches
  • leg raises
  • pelvic tilts
  • single and double knee-to-chest stretches
  • squats

Your therapist may suggest using a ball or wall for support during some of these exercises.

If improvement does not occur after several months of first-line treatments, your doctor may recommend surgery. There are a few options, including laminectomy and spinal fusion.

Find out who makes a good candidate for spinal fusion here.

What is the outlook for those with anterolisthesis?

For the two most common causes of anterolisthesis, nonsurgical treatment is usually successful. Surgery can also be successful: More than 85% of people who have surgery for spondylolisthesis find relief.

Most young people with overuse anterolisthesis recover within a few months. They are usually able to return to sports and other activities. Complications and recurrence are not common.

Other frequently asked questions

Here are some other questions that people ask about anterolisthesis.

Is anterolisthesis serious? 

The seriousness of anterolisthesis depends on the grade. Grades 1 and 2 are mild to moderate. People with these grades may not have pain or other symptoms. This is especially true for younger people with the condition. Grades 3 and 4 are more serious than the previous two.

Can you reverse anterolisthesis?

Anterolisthesis often remains stable over time. Once the slippage occurs, it is most likely permanent. When it is due to degenerative changes, the process can continue. It can eventually cause spinal stenosis, narrowing the space inside your spine. Nonsurgical treatments can often increase function and reduce symptoms. Surgery can repair the slippage.


Anterolisthesis occurs when a spinal vertebra slips forward relative to the one below it. The most common causes are spinal degeneration in older adults and a vertebral stress fracture in adolescents. People with mild or moderate slippage may not have any symptoms. Those with significant spinal degeneration typically have low back and leg pain. Other leg symptoms can include weakness, numbness, or tingling.

Nonsurgical treatments are often helpful in relieving symptoms and maintaining function. Surgery may be necessary to realign the vertebrae. Doctors may recommend spinal fusion in some cases.

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Medical Reviewer: Angela M. Bell, MD, FACP
Last Review Date: 2022 Jun 30
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