Spondylolisthesis

Medically Reviewed By William C. Lloyd III, MD, FACS
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What is spondylolisthesis?

Spondylolisthesis occurs when one of the vertebrae in your spine shifts out of place. It is often due to normal wear and tear of the spinal discs, vertebrae and joints—the facet joints. This is degenerative spondylolisthesis. A small crack or fracture in one of the bones—the isthmus—connecting the joints can also cause vertebral slippage. This is spondylolytic, or isthmic spondylolisthesis.

The vertebral shift in people with spondylolisthesis can put pressure on the spinal nerve roots as they exit the spinal canal in between each vertebra. The condition can be quite painful. Lumbar spondylolisthesis in the lumbar (lower) spine is the most common form, so pain symptoms usually start in that area of the back. The low back pain might feel like a muscle strain and could extend to the buttocks and back of the thighs.

Older people have a higher risk of developing degenerative spondylolisthesis as a normal part of aging because the normally thick discs in between each vertebra begin to wear out. Women and African Americans also have a higher risk of degenerative spondylolisthesis. People who play sports that put a strain on the lower back are at risk of developing spondylolytic spondylolisthesis later in life. With this form, people often don’t have pain symptoms and may not know they have the condition until they have X-rays for another reason.

Depending on how severe the shift is and how much pain it’s causing, you may have several different treatment options. If you have a low degree of slippage, pain medication and physical therapy might be all you need. Surgery is an option if you have a severe slip or pain that doesn’t get better with nonsurgical treatment.

Without spondylolisthesis treatment, you may continue experiencing pain and eventually have permanent nerve damage. The condition could also lead to an abnormal inward or outward curvature of the back.

What are the symptoms of spondylolisthesis?

Some people do not experience spondylolisthesis symptoms, while other people feel near-constant pain. Symptoms depend on the grade of slippage. Visible symptoms can include swayback, which is when the lower back has an abnormal inward curve, or roundback, when the spine bows out. Other common symptoms of spondylolisthesis include:

  • Lower back pain, which is often worse when standing or walking but lessens when sitting or lying down

  • Pain, numbness or tingling that extends to the buttocks or thighs

  • Stiffness or tenderness

  • Tightness of the hamstring muscles

  • Weak legs

If you experience persistent symptoms, or if you notice an abnormal curve in your back, see your doctor. He or she may ask you to have X-rays or other imaging tests to check for spondylolisthesis and rule out other possible causes.

What causes spondylolisthesis?

The two most common types of spondylolisthesis are degenerative spondylolisthesis and spondylolytic (isthmic) spondylolisthesis.

General wear and tear of the spine is normal as people get older, and it can sometimes cause degenerative spondylolisthesis. The spongy disc material between the vertebrae begins to dry out, stiffen and bulge. This ultimately weakens the spinal joints, causing one vertebra to slip forward over the one below it. This condition begins to cause pain when the shifted vertebra presses on the spinal cord or nerve roots extending away from the spinal cord.

Spondylolytic spondylolisthesis results from a fracture that allows a vertebra, usually in the lower back, to slip forward. Repeated hyperextension of the lumbar spine can cause this type of break.

Other, less common types of spondylolisthesis include:

  • Congenital spondylolisthesis, which is caused by an abnormal bone formation before birth
  • Traumatic spondylolisthesis, which happens after a sudden spinal injury

  • Pathologic spondylolisthesis, which is caused by an infection or disease, such as osteoporosis or cancer

  • Postsurgical spondylolisthesis, which is caused by a vertebra shift after surgery

What are the risk factors for spondylolisthesis?

The biggest risk factor for degenerative spondylolisthesis is older age. Women develop it more often than men. Black Americans and people of African American descent have a higher risk of developing the condition compared to White Americans.

Young athletes who play sports that overextend the lumbar spine, such as gymnasts, weightlifters, and football players, have a higher risk of developing spondylolytic spondylolisthesis later in life. The condition typically shows up in middle-aged men.

Reducing your risk of spondylolisthesis

To lower your risk of developing spondylolisthesis:

  • Get regular exercise to strengthen your back and abdominal muscles

  • Choose low-impact sports, such as swimming and biking

  • Maintain a healthy weight so you don’t add extra strain on your spine

  • Eat a healthy diet including enough calcium and vitamin D to keep your bones strong

If you’re at higher risk for spondylolisthesis, talk with your doctor about whether you should have spine imaging tests as a proactive measure.

How is spondylolisthesis treated?

Spondylolisthesis treatment options depend on the grade, or severity of spondylolisthesis. See an orthopedic surgeon or neurosurgeon who specializes in the spine for accurate spondylolisthesis grading. For grade 1 or grade 2 spondylolisthesis, which are less serious, your doctor will likely recommend nonsurgical treatment. Surgery may be necessary for more severe grade 3 or grade 4 spondylolisthesis.

Nonsurgical treatments begin with rest and possibly pain medications, including nonsteroidal anti-inflammatory drugs. Cortisone injections also may help reduce inflammation. A physical therapist can teach you effective spondylolisthesis exercises to strengthen and stretch your back muscles, which help protect your spine. Your doctor may recommend wearing a back brace to limit movement and provide support. You’ll probably need to try nonsurgical treatment for up to a year before considering surgery.

Spondylolisthesis surgery is an option if the vertebra continues to shift out of place or if nonsurgical treatments don’t relieve the pain, especially if the condition prevents you from doing your everyday activities. During the procedure, the surgeon will fuse the slipped vertebrae together to stabilize your spine and relieve painful pressure on the spinal nerve(s). The bone may take several months to fully heal after spinal fusion.

What are the potential complications of spondylolisthesis?

Left untreated, spondylolisthesis may result in continued pain and possibly disability. If the condition interferes with your daily routine leading to inactivity, you may begin to gain weight or lose bone density and muscle strength. In addition, nerve damage from continued pressure (spinal nerve compression) can be permanent.

If the surgeon recommends surgery, consider all your treatment options before making a final decision. Ask your doctor about spondylolisthesis surgery benefits and potential complications, which may include bleeding problems, infection, and damage to nearby nerves. Investigate your doctor’s background and experience performing the procedure he or she recommends. The chances of a successful outcome are best with an experienced surgeon who has performed the procedure at a high-quality hospital many times with a very low complication rate.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2020 Aug 22
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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