Spondylolisthesis: Symptoms, Treatment, & Surgery

What is Spondylolisthesis

Spondylolisthesis is the displacement or dislocation of a vertebra. It most commonly occurs in the lower back, but it can affect any region of the spinal column. In most cases, the affected vertebra protrudes forward over the vertebra directly beneath it, impinging or compressing the nerves in the back.

Spondylolisthesis Symptoms

Common symptoms of spondylolisthesis include a sudden pain that radiates down the back or buttocks and becomes more severe when bending or twisting, a sense of weakness in the legs, and an inability to walk without significant pain. In particularly extreme cases, it can also lead to incontinence.

Spondylolisthesis Grading

Spondylolisthesis can be categorized by the extent of the displacement in relation to the length of the vertebra. If 30% of a vertebra hangs over the vertebra beneath it, for example, the displacement is a grade 2 case of spondylolisthesis.

Grade 1 Spondylolisthesis

In Grade 1 spondylolisthesis, 0% to 25% of the vertebra hangs over the vertebra beneath it.

Grade 2 Spondylolisthesis

In Grade 1 spondylolisthesis, 25% to 50% of the vertebra hangs over the vertebra beneath it.

Grade 3 Spondylolisthesis

In Grade 1 spondylolisthesis, 50% to 75% of the vertebra hangs over the vertebra beneath it.

Grade 4 Spondylolisthesis

In Grade 1 spondylolisthesis, 75% to 100% of the vertebra hangs over the vertebra beneath it.

Grade 5 Spondylolisthesis

In Grade 1 spondylolisthesis, the entire vertebra hangs over the vertebra beneath it.

Spondylolisthesis Treatment

Treatments for spondylolisthesis depend on the severity of the condition, but most cases respond well to more conservative measures. Indeed, surgery is generally necessary only if the displacement has significantly limited the patient’s ability to function.

Conservative

The first line of treatment for spondylolisthesis is to simply refrain from any activity that might have caused the displacement or could exacerbate it. Minor to moderate pain can be effectively relieved with ibuprofen or acetaminophen. Corticosteroid injections can also alleviate pain and swelling. These treatments should be complemented with a physical therapy program, specifically flexion exercises, which are designed to rebuild the muscles in the core and back while restoring function to the affected vertebra.

Spondylolisthesis Surgery

Should the condition result in damage to the nerves or surrounding vertebrae, spondylolisthesis can also be treated with surgery. During this procedure, your surgeon will remove any bone or tissue that might be compressing the nerves and fuse the vertebrae together to prevent further displacement. This surgery can be performed openly or arthroscopically, and complete recovery can be expected after several months of rest and physical therapy.

Spondylolisthesis: FAQs

What is spondylolisthesis, and what causes it?

Spondylolisthesis is a condition in which one vertebra slips forward over the one below it, potentially causing back pain, nerve irritation, or instability. Common causes include degenerative changes (wear and tear), congenital defects, stress fractures (isthmic type), trauma, or pathology that weakens the bone.

What symptoms should I expect with spondylolisthesis?

Symptoms vary by severity. Many people have mild slippage and little to no symptoms. When present, symptoms often include lower back pain, stiffness, muscle tightness, leg pain or sciatic symptoms, numbness or tingling in the legs or feet, difficulty standing or walking for long periods, and sometimes weakness in the legs. In severe cases, bladder or bowel symptoms may occur.

What non-surgical treatments are available for spondylolisthesis?

Conservative treatment is usually the first step. This can include physical therapy (core & back strengthening, posture correction), use of braces or supports, pain-relieving medications or injections, activity modification, and lifestyle changes (weight management, avoiding aggravating movements). These treatments often help many patients avoid surgery.

When is surgery considered, and what does recovery entail?

Surgery is considered when non-surgical treatments fail to relieve symptoms, when slippage is severe, or when there is neurological impairment (e.g. nerve compression causing weakness or loss of function). Common surgical options include decompressive procedures (e.g. laminectomy or foraminotomy) and spinal fusion to stabilize the spine. Recovery involves several weeks of restricted activity, gradual physical therapy, and may take several months to a year for full recovery depending on the procedure, grade of slippage, patient health, and adherence to rehabilitation.