Spondylolisthesis: Symptoms, Causes & Treatment

Spondylolisthesis is a condition in which a vertebra of the spine slips from its place forward relative to the vertebra below it. It most often occurs in the lower part of the spine (the lumbosacral region). This differs from a herniated disc, as spondylolisthesis concerns the slipping of the bone (vertebra) itself, not the disc between the vertebrae. Its severity varies by the degree of slippage, and many mild cases cause no symptoms and are found incidentally on an X-ray.

Spondylolisthesis has multiple causes: the degenerative type, the most common, occurring with aging due to weakness of the joints and ligaments; the type resulting from a crack or weakness in part of the vertebra (common in adolescents and young athletes especially in sports requiring excessive backward bending of the back like gymnastics); and congenital types or those resulting from injuries. When spondylolisthesis causes symptoms, they include: lower back pain that increases with activity, standing, and bending backward and eases with rest, stiffness and tightness in the back muscles and hamstrings, and sometimes pain, numbness, or tingling extending to the buttocks and legs if the slipped vertebra presses on the nerves, and walking may be affected in more severe cases.

Spondylolisthesis is diagnosed by clinical examination and X-ray (which shows the slippage and its degree), and sometimes MRI to assess nerve pressure. Treatment depends on the degree of slippage and the severity of symptoms. Most cases are successfully managed with conservative treatment without surgery: relative rest and activity modification, painkillers and anti-inflammatories, and most importantly physical therapy with an exercise program to strengthen and stretch the trunk, abdominal, and back muscles and improve posture and spine stability, and sometimes local injections. Many patients improve with these measures. Surgery is reserved for cases with severe or advanced slippage, or nerve pressure causing increasing weakness or severe pain not responding to conservative treatment. It is important to see a doctor for persistent back pain or pain extending to the leg, especially in adolescent athletes, and to start appropriate rehabilitation.

• Lower back pain that increases with activity and bending backward and eases with rest.
• Stiffness and tightness in the back muscles and hamstrings.
• Sometimes pain or numbness extending to the buttocks and legs (nerve pressure).
• Many mild cases are symptomless.

• The degenerative type with aging (the most common).
• A crack or weakness in part of the vertebra (common in adolescent athletes).
• Congenital types or those resulting from injuries.

• Clinical examination and X-ray (which shows the slippage and its degree).
• MRI when nerve pressure is suspected.
• Special evaluation for adolescent athletes with persistent back pain.

Conservative treatment (sufficient for most cases)

• Relative rest and activity modification.
• Painkillers and anti-inflammatories.
• Physical therapy with exercises to strengthen the trunk, abdomen, and back and improve posture (the most important).
• Sometimes local injections.

Surgery

• For severe or advanced slippage, or nerve pressure not responding to conservative treatment.

This content is educational and does not replace medical advice.

• Chronic back pain and stiffness.
• Nerve pressure causing numbness or weakness in the leg.
• Progression of the slippage degree in some cases.

• Strengthening the trunk, abdomen, and back muscles to maintain spine stability.
• Proper movement and lifting techniques and avoiding excessive backward bending of the back in sports.
• Not neglecting persistent back pain especially in adolescent athletes.