Spondylolisthesis Occurs When a Vertebra Slips Forward

Spondylolisthesis is a lumbar (low back) disorder that occurs when a vertebral body slips forward horizontally over the one beneath. Spondylolisthesis may develop from stressful forces, degenerative changes in the spine, certain types of spinal fractures, and may even be found at birth (congenital). Some people are predisposed to this condition due to hereditary factors. Common symptoms include lower back and leg pain.

The severity of a spondylolisthesis “forward slip” is measured using a 5-point scale.

  • Grade 1 = ≤25%
  • Grade 2 = 50%
  • Grade 3 = 75%
  • Grade 4 = 100%
  • Grade 5 = vertebral body has completed slid off the adjacent vertebra (called spondyloptosis)

Spondylolisthesis can be caused when the pars interarticularis (pars) is damaged. The pars is a bony supportive structure that connects to the facet joints. Stress-related micro-fractures or a complete fracture (rare, usually trauma-related) causes the pars to separate or split apart creating a spondylolisthesis.

Spondylolisthesis Symptoms

  • Low back pain is the foremost symptom of spondylolisthesis. Bending forward (flexion) often increases pain, while bending backward (extension) eases pain.
  • Muscle spasms
  • Muscle weakness
  • Numbness, tingling sensations
  • Tenderness in the area of the spondylolisthesis
  • Oddly, the Grade of the spondylolisthesis (eg, Grade 2 vs Grade 3) does not determine the severity of pain.
  • Nerve compression may cause leg pain to develop.
  • Often, tightness of the hamstring muscles in the legs is the first visible sign of a spondylolisthesis.

Diagnosing a Spondylolisthesis

The neurosurgeon’s evaluation includes an in-depth review of the patient’s medical history, including involvement in certain sports, such as weight-lifting, jumping, or other high-impact activities. After he completes a thorough physical and neurological examination, an imaging study (eg, x-ray, CT scan, MRI) is performed to confirm a spondylolisthesis diagnosis.

Spondylolisthesis Treatment

Most patients with a spondylolisthesis do not need spine surgery.

Non-operative treatment options may include:

  • Pain medication
  • Anti-inflammatory drugs
  • Activity modification
  • Bracing
  • Spinal injection(s)
  • Physical therapy

Surgery may be considered if non-operative treatments do not adequately relieve the patient’s symptoms after reasonable period of time. Immediate surgery may be recommended if neurological problems are present, such as bowel or bladder dysfunction.

Surgical treatment of spondylolisthesis may involve:

  • Spinal decompression removes bone and/or tissue causing nerve compression.
  • Spinal fusion joins two vertebral bodies using either bone graft alone or with spinal instrumentation. Spinal instrumentation may involve implanting an interbody device (eg, cage), rods, and screws to immediately stabilize the spine. Furthermore, instrumentation stops the spondylolisthesis from slipping further.

Charleston Brain and Spine welcome your questions about spondylolisthesis, as well as other spinal conditions that cause back pain. Our neurosurgeons take the time necessary to help you understand why you have back pain, and explain the cause in terms you will understand. If you are considering a second opinion, we’d be pleased to evaluate your spinal disorder.