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Spondylolisthesis and spondylolysis

Peer reviewed by Dr Laurence Knott Last updated by Dr Colin Tidy, MRCGP Last updated 20 Nov 2021

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In this article :

What is spondylolisthesis, spondylolisthesis vs spondylolysis.

• Who gets spondylolisthesis and spondylolysis? (Epidemiology)

Spondylolisthesis causes (aetiology)

• Types of spondylolisthesis
• Presentation

Differential diagnosis

Investigations.

• Spondylolisthesis treatment and management

Complications of surgical repair

Spondylolisthesis prognosis.

Continue reading below

Spondylolisthesis is the movement of one vertebra relative to the others in either the anterior or posterior direction due to instability. Degenerative spondylolisthesis is a common pathology, often causing lumbar canal stenosis 1 .

Anatomy of the vertebrae

The vertebrae can be divided into three portions:

Centrum - involved in weight bearing. This is the body of the vertebra and is formed of cancellous bone.

Dorsal arch - surrounds and protects the spinal cord. It carries the upper and lower facet joints of each vertebra which articulate with the facet joints of the vertebra above and below, respectively. The part of the vertebral arch between them is the thinnest part and is called the pars interarticularis, or the isthmus.

Posterior aspect - protrudes and can be palpated on the lower back.

Lumbar vertebra 1 inferior surface

Lumbar vertebra 1 anterior surface

Images by Anatomography, via Wikimedia Commons . Click here to see a lumbar vertebra 1 close-up superior surface animation.

Spondylolysis and spondylolisthesis are separate conditions, although spondylolysis often precedes spondylolisthesis.

Spondylolysis is a bony defect (commonly due to a stress fracture but it may be a congenital defect) in the pars interarticularis of the vertebral arch, separating the dorsum of the vertebra from the centrum. It may occur unilaterally or bilaterally. It most commonly affects the fifth lumbar vertebra and may cause back pain.

Spondylolisthesis refers to the anterior slippage of one vertebra over another (or the fifth vertebra over the sacrum). There are five forms:

Isthmic : the most common form, usually acquired in adolescence as a consequence of spondylolysis but often unnoticed until adulthood.

Degenerative : developing in older adults as a result of facet joint osteoarthritis and bone remodelling.

Traumatic (rare): resulting from fractures of the neural arch.

Pathologic : from metastases or metabolic bone disease.

Dysplastic : (rare): congenital, resulting from malformation of the pars.

Spondylosis is a general term for degenerative osteoarthritic changes in the spine. It involves dehydration of the intervertebral discs with consequent narrowing of the intervertebral spaces. There may be changes in the facet joints with osteophyte formation and this may put pressure on the nerve roots, causing motor and sensory disturbance.

Who gets spondylolisthesis and spondylolysis? (Epidemiology) 2

Spondylolysis is a common diagnosis with a high prevalence in children and adolescents complaining of low back pain.

There is an increased risk of spondylolysis in young athletes like gymnasts, presumably due to impact-related stress fractures . However most cases are low-grade. At-risk activities include gymnastics, diving, tennis, cricket, weightlifting, football and rugby.

Isthmic spondylolisthesis affects around 5% of the population but is more common in young athletes. 60-80% of people with spondylolysis have associated spondylolisthesis 3 4 .

The majority of cases of spondylolysis and spondylolisthesis affect L5 and most of the remainder affect L4.

Degenerative spondylolisthesis is more common in older people, particularly women.

Traumatic, metastatic and dysplastic spondylolistheses are relatively rare.

Many cases of spondylolisthesis are asymptomatic.

Spondylolisthesis commonly occurs due to a fracture or defect in the pars interarticularis, the narrowest part of the posterior vertebral arch between the upper and lower facet joints. When this is breached, the upper facet joint may no longer be able to hold the vertebra in place against the downward force of body weight and forward/downward slippage occurs.

Risk factors that increase the risk of spondylolysis developing into spondylolisthesis include 5 :

Female gender.

Presence of spina bifida or spina bifida occulta .

Vertebral wedging.

Hyperlordosis.

Positive family history.

Certain high-impact sports, as evidenced by increased rates in athletes and gymnasts 3 .

Types of spondylolisthesis 2

Stable or unstable.

Asymptomatic or symptomatic.

Graded according to degree of slippage; the Meyerding classification is based on the ratio of the overhanging part of the superior vertical body to the anterio-posterior length of the inferior vertebral body:

Grade I: 0-25%.

Grade II: 26-50%.

Grade III: 51-75%.

Grade IV: 76-100%.

Grade V (spondyloptosis): >100%.

Graded according to type; the Wiltse classification (1976):

Type I: dysplastic (congenital).

Type II: isthmic: secondary to a lesion involving the pars interarticularis:

Subtype A: secondary to stress fracture.

Subtype B: result of multiple healed stress fractures resulting in an elongated pars.

Subtype C: acute pars fracture (rare).

Type III: degenerative.

Type IV: post-traumatic: fracture in a region other than the pars.

Type V: pathological: diffuse or local disease.

Type VI: iatrogenic.

Presentation 4

Spondylolysis symptoms.

Most cases of spondylolysis are asymptomatic and identified incidentally.

It may present with low back pain provoked by lumbar extension, paraspinal spasm and tight hamstrings.

It frequently does not show on X-ray. It is important to consider it in the differential diagnosis of back pain, as its identification can prevent progression and avoid the potential need for aggressive intervention.

Spondylolisthesis symptoms

Presentation varies slightly by type although common spondylolisthesis symptoms include exercise-related back pain, radiating to the lower thighs, which tends to be eased by rest, particularly in positions of spinal flexion.

Isthmic spondylolisthesis

Most patients are asymptomatic, even with progressing slippage.

Symptoms often begin around the adolescent growth spurt.

Back pain - worse with activity (particularly back extension) - this may come on acutely or insidiously.

Pain may flare with sudden or trivial activities and is relieved by resting.

Pain is worse with higher grades of disease.

Pain may radiate to buttocks or thighs

There are usually no neurological features with lower grades of slippage but radicular pain becomes common with larger slips. Pain below the knee due to nerve root compression or disc herniation would suggest more severe slippage. High degrees of spondylolisthesis may present with neurogenic claudication or even cauda equina impingement.

Tightened hamstrings are very common

There may be enhanced lordosis and a waddling gait with shortened step length.

There may be gluteal muscular wasting.

Degenerative spondylolisthesis

Pain is aching in nature and insidious in onset.

Pain is in the low back and posterior thighs.

Neurogenic claudication may be present with lower-extremity symptoms worsening with exercise.

Symptoms are often chronic and progressive, sometimes with periods of remission.

If lumbar stenosis is also present, reflexes may be diminished.

Dysplastic spondylolisthesis

Presentation and physical findings are similar to isthmic spondylolisthesis but with a greater likelihood of neurological compromise.

Traumatic spondylolisthesis

Patients will have experienced acute trauma and are likely to have significant pain.

Severe slips may cause cauda equina compression with bladder and bowel dysfunction, radicular symptoms or neurogenic claudication.

Physical findings are as for the other types.

Pathological spondylolisthesis

Symptoms may be insidious in onset and associated with radicular pain.

Other causes of back pain need to be ruled out - eg:

Osteoarthritis .

Ankylosing spondylitis .

Mechanical lower back pain .

Spinal cord lesion.

Multiple myeloma .

Vertebral compression fracture .

Lumbar disc prolapse.

Discitis/other spinal disc problems .

Blood tests - looking for infection, myeloma, hypercalcaemia/hypocalcaemia.

Lateral spinal X-rays - will show spondylolisthesis. These are best performed in the position of maximal pain.

Oblique spinal X-rays - may (but will often not) detect spondylolysis.

Radionuclide scintigraphy and CT may help in cases of spondylolysis in distinguishing progressing lesions of the pars from stable lesions.

MRI is often performed perioperatively to look at relationships between the bony and neurological structures in the compromised area.

Spondylolisthesis treatment and management 1 2 4

The goal of treatment is to relieve pain, stabilise the spinal segment and stop or reverse the slippage. Patients need to be evaluated for the presence of instability, as if there is an unstable segment early surgery will be needed.

Depending on the severity of the spondylolysis and symptoms associated it may be treated either conservatively or surgically, both of which have shown significant success.

Conservative treatments such as bracing and decreased activity have been shown to be most effective with patients who have early diagnosis and treatment. Low-intensity pulsed ultrasound in addition to conservative treatment appears to achieve a higher rate of bony union. Surgery may be required if conservative treatment, for at least six months, failed to give sustained pain relief for the activities of daily living.

For degenerative spondylolisthesis, surgery is indicated mainly for perceived functional impairment. Improvement in neurological symptoms is one of the main treatment objectives. For this, it is useful to perform radicular decompression. The most frequent technique is direct posterior decompression.

Conservative treatment

Complete bed rest for 2-3 days can be helpful in relieving pain, particularly in spondylolysis, although longer periods are likely to be counterproductive. Patients should try to sleep on their side as much as possible, with a pillow between the knees.

Activity modification to prevent further injury. This may mean avoidance of activities if there is >25% slippage.

Analgesia - eg, paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs), codeine phosphate.

Steroid and local anaesthetic injections are sometimes used around compressed nerve roots or even into the fracture area of the pars for diagnostic purposes.

Bracing: a brace or corset may be recommended for a pars interarticularis fracture which is likely to heal. Bracing with exercise may be beneficial for patients with mild or even more severe degrees of slippage.

Physiotherapy: this includes massage, ultrasound, bracing, mobilisation, biomechanical correction, hydrotherapy, exercises for flexibility, strength and core stability and a gradual return to activity programme.

More than 80% of children treated non-surgically will have full resolution of symptoms.

A meta-analysis of observation studies suggested that around 80% of all patients treated non-operatively would have a successful clinical outcome after one year. Lesions diagnosed at the acute stage and unilateral lesions were the best subgroups 6 .

Surgical treatment

If there is evidence of progression or if conservative measures are ineffective then surgical therapy may be offered. This depends also on degree and aetiology.

Surgical intervention involves a prolonged rehabilitation period so it is generally not considered until conservative treatments have failed. An exception would be in the case of significant instability or neurological compromise and in high-grade slips.

Surgical therapy involves fusing the affected vertebra with a neighbouring normally aligned vertebra (both anteriorly and posteriorly). The intervertebral disc is usually also removed, as it is inevitably damaged. The slipped vertebra may be realigned.

Whilst most surgeons agree that decompression of the nerves is of benefit to patients, the benefit of realigning slipped vertebrae is uncertain. For example, when the spondylolisthesis is very gradual in onset, or in cases of congenital spondylolisthesis, compensatory changes in the spine and musculature occur so that realignment may increase the possibility of further injury.

There is good evidence that surgical treatment of symptomatic spondylolisthesis is significantly superior to non-surgical management in the presence of 7 :

Significant neurological deficit.

Failed response to conservative therapy.

Instability with neurological symptoms.

Degree of subluxation of III or more.

Unremitting pain affecting quality of life.

A large systematic review concluded that reduction of displacement carried benefits over fusion alone, although a large retrospective review showed high complication rates, particularly for older patients with more severe disease 8 9 10 11 .

Fusion techniques can be associated with neurological complications in older patients with degenerative spondylolisthesis, but in adolescent patients outcomes are good 9 .

Surgery is commonly complicated by pseudoarthrosis (non-union) which may result in chronic pain years down the line.

In the case of spondylolysis, if surgery is offered it would involve pinning the defect. However, most cases are managed conservatively.

Implant failure.

Pseudoarthrosis (failure of bone healing leading to a 'false joint').

Poor alignment of the fusion.

Neurological damage: foot drop, spinal cord compression . Chronic nerve injury/inflammation: neuropathic pain can persist in the face of apparent surgical success, possibly due to permanent changes in the nerves or a deregulation of pain control mechanisms.

Spondylolisthesis is generally a benign condition; however, it runs a chronic course and is therefore a cause of much morbidity and disability. In degenerative spondylolisthesis this will relate in part to the progress and prognosis of the underlying changes.

Dr Mary Lowth is an author or the original author of this leaflet.

Further reading and references

• Guigui P, Ferrero E ; Surgical treatment of degenerative spondylolisthesis. Orthop Traumatol Surg Res. 2017 Feb;103(1S):S11-S20. doi: 10.1016/j.otsr.2016.06.022. Epub 2016 Dec 30.
• Gagnet P, Kern K, Andrews K, et al ; Spondylolysis and spondylolisthesis: A review of the literature. J Orthop. 2018 Mar 17;15(2):404-407. doi: 10.1016/j.jor.2018.03.008. eCollection 2018 Jun.
• Toueg CW, Mac-Thiong JM, Grimard G, et al ; Prevalence of spondylolisthesis in a population of gymnasts. Stud Health Technol Inform. 2010;158:132-7.
• Syrmou E, Tsitsopoulos PP, Marinopoulos D, et al ; Spondylolysis: a review and reappraisal. Hippokratia. 2010 Jan;14(1):17-21.
• Sadiq S, Meir A, Hughes SP ; Surgical management of spondylolisthesis overview of literature. Neurol India. 2005 Dec;53(4):506-11.
• Klein G, Mehlman CT, McCarty M ; Nonoperative treatment of spondylolysis and grade I spondylolisthesis in children and young adults: a meta-analysis of observational studies. J Pediatr Orthop. 2009 Mar;29(2):146-56. doi: 10.1097/BPO.0b013e3181977fc5.
• Alfieri A, Gazzeri R, Prell J, et al ; The current management of lumbar spondylolisthesis. J Neurosurg Sci. 2013 Jun;57(2):103-13.
• Weinstein JN, Lurie JD, Tosteson TD, et al ; Surgical compared with nonoperative treatment for lumbar degenerative spondylolisthesis. four-year results in the Spine Patient Outcomes Research Trial (SPORT) randomized and observational cohorts. J Bone Joint Surg Am. 2009 Jun;91(6):1295-304. doi: 10.2106/JBJS.H.00913.
• Sansur CA, Reames DL, Smith JS, et al ; Morbidity and mortality in the surgical treatment of 10,242 adults with spondylolisthesis. J Neurosurg Spine. 2010 Nov;13(5):589-93. doi: 10.3171/2010.5.SPINE09529.
• Kasliwal MK, Smith JS, Kanter A, et al ; Management of high-grade spondylolisthesis. Neurosurg Clin N Am. 2013 Apr;24(2):275-91. doi: 10.1016/j.nec.2012.12.002. Epub 2013 Feb 21.
• Longo UG, Loppini M, Romeo G, et al ; Evidence-based surgical management of spondylolisthesis: reduction or arthrodesis in situ. J Bone Joint Surg Am. 2014 Jan 1;96(1):53-8. doi: 10.2106/JBJS.L.01012.

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StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

StatPearls [Internet].

Spondylolisthesis.

Steven Tenny ; Andrew Hanna ; Christopher C. Gillis .

Affiliations

Last Update: May 22, 2023 .

• Continuing Education Activity

Spondylolisthesis is a condition that occurs when one vertebral body slips with respect to the adjacent vertebral body causing radicular or mechanical symptoms or pain. It is graded based on the degree of slippage of one vertebral body on the adjacent vertebral body. Any pathological process that can weaken the supports keeping vertebral bodies aligned can allow spondylolisthesis to occur. This activity illustrates the evaluation and management of spondylolisthesis and reviews the role of the interprofessional team in improving care for patients with this condition.

• Describe the pathophysiology of spondylolisthesis.
• Review the workup of a patient with spondylolisthesis.
• Summarize the treatment options for spondylolisthesis.
• Describee the importance of collaboration and communication among the interprofessional team in encouraging weight loss in patients to reduce symptoms and increase the quality of life in those with spondylolisthesis.
• Introduction

Spondylolisthesis is the slippage of one vertebral body with respect to the adjacent vertebral body causing mechanical or radicular symptoms or pain. It can be due to congenital, acquired, or idiopathic causes. Spondylolisthesis is graded based on the degree of slippage of one vertebral body on the adjacent vertebral body. [1]

Spondylolisthesis commonly classifies as one of five major etiologies: degenerative, isthmic, traumatic, dysplastic, or pathologic. Degenerative spondylolisthesis occurs from degenerative changes in the spine without any defect in the pars interarticularis. It is usually related to the combined facet joint and disc degeneration leading to instability and forward movement of one vertebral body relative to the adjacent vertebral body. Isthmic spondylolisthesis results from defects in the pars interarticularis. The cause of isthmic spondylolisthesis is undetermined, but a possible etiology includes microtrauma in adolescence related to sports such as wrestling, football, and gymnastics, where repeated lumbar extension occurs. Traumatic spondylolisthesis occurs after fractures of the pars interarticularis or the facet joint structure and is most common after trauma. Dysplastic spondylolisthesis is congenital and secondary to variation in the orientation of the facet joints to an abnormal alignment.  In dysplastic spondylolisthesis, the facet joints are more sagittally oriented than the typical coronal orientation. Pathologic spondylolisthesis can be from systemic causes such as bone or connective tissue disorders or a focal process, including infection, neoplasm, or iatrogenic origin. Additional risk factors for spondylolisthesis include a first-degree relative with spondylolisthesis, scoliosis, or occult spina bifida at the S1 level. [1]

• Epidemiology

Spondylolisthesis most commonly occurs in the lower lumbar spine but can also occur in the cervical spine and rarely, except for trauma, in the thoracic spine. Degenerative spondylolisthesis predominately occurs in adults and is more common in females than males with increased risk in the obese. Isthmic spondylolisthesis is more common in the adolescent and young adult population but may go unrecognized until symptoms develop in adulthood. There is a higher prevalence of isthmic spondylolisthesis in males. Dysplastic spondylolisthesis is more common in the pediatric population, with females more commonly affected than males. Current estimates for prevalence are 6 to 7% for isthmic spondylolisthesis by the age of 18 years, and up to 18% of adult patients undergoing MRI of the lumbar spine. Grade I spondylolisthesis accounts for 75% of all cases. Spondylolisthesis most commonly occurs at the L5-S1 level with an anterior translation of the L5 vertebral body on the S1 vertebral body. The L4-5 level is the second most common location for spondylolisthesis. 

• Pathophysiology

Any process that can weaken the supports keeping vertebral bodies aligned can allow spondylolisthesis to occur. As one vertebra moves relative to the adjacent vertebrae, local pain can occur from mechanical motion or radicular or myelopathic pain can occur due to compression of the exiting nerve roots or spinal cord, respectively. Pediatric patients are more likely to increase spondylolisthesis grade when going through puberty. Older patients with lower grades I or II spondylolistheses are less likely to progress to higher grades over time.

• History and Physical

Patients typically have intermittent and localized low back pain for lumbar spondylolisthesis and localized neck pain for cervical spondylolisthesis. The pain is exacerbated by flexing and extending at the affected segment, as this can cause mechanic pain from motion. Pain may be exacerbated by direct palpation of the affected segment. Pain can also be radicular in nature as the exiting nerve roots become compressed due to the narrowing of nerve foramina as one vertebra slips on the adjacent vertebrae, the traversing nerve root (root to the level below) can also be impinged through associated lateral recess narrowing, disc protrusion, or central stenosis. Pain can sometimes improve in certain positions such as lying supine. This improvement is due to the instability of the spondylolisthesis that reduces with supine posture, thus relieving the pressure on the bony elements as well as opening the spinal canal or neural foramen. Other symptoms associated with lumbar spondylolisthesis include buttock pain, numbness, or weakness in the leg(s), difficulty walking, and rarely loss of bowel or bladder control.

Anteroposterior and lateral plain films, as well as lateral flexion-extension plain films, are the standard for the initial diagnosis of spondylolisthesis. One is looking for the abnormal alignment of one vertebral body to the next as well as possible motion with flexion and extension, which would indicate instability. In isthmic spondylolisthesis, there may be a pars defect, which is termed the "Scotty dog collar." The "Scotty dog collar" shows a hyperdensity where the collar would be on the cartoon dog, which represents the fracture of the pars interarticularis. Computed tomography (CT) of the spine provides the highest sensitivity and specificity for diagnosing spondylolisthesis. Spondylolisthesis can be better appreciated on sagittal reconstructions as compared to axial CT imaging. MRI of the spine can show associated soft tissue and disc abnormalities, but it is relatively more challenging to appreciate bony detail and a potential pars defect on MRI. [2] [3]

• Treatment / Management

For grade I and II spondylolisthesis, treatment typically begins with conservative therapy, including nonsteroidal anti-inflammatory drugs (NSAIDs), heat, light exercise, traction, bracing, and/or bed rest. Approximately 10% to 15% of younger patients with low-grade spondylolisthesis will fail conservative treatment and need surgical treatment. No definitive standards exist for surgical treatment. Surgical treatment includes a varying combination of decompression, fusion with or without instrumentation, or interbody fusion. Patients with instability are more likely to require operative intervention.  Some surgeons recommend a reduction of the spondylolisthesis if able as this not only decreases foraminal narrowing but also can improve spinopelvic sagittal alignment and decrease the risk for further degenerative spinal changes in the future. The reduction can be more difficult and riskier in higher grades and impacted spondylolisthesis. [4] [5] [6] [7] [8] [2] [9] [10]

• Differential Diagnosis
• Degenerative  Lumbar Disc Disease
• Lumbar Disc Problems
• Lumbosacral Disc Injuries
• Lumbosacral Discogenic Pain Syndrome
• Lumbosacral Facet Syndrome
• Lumbosacral Radiculopathy
• Lumbosacral Spine Acute Bony Injuries
• Lumbosacral Spondylosis
• Myofascial Pain in Athletes
• Pearls and Other Issues

Meyerding’s classification of spondylolisthesis is the most commonly used grading method. Its basis is on the percentage of anterior translation relative to the adjacent level. Grade I spondylolisthesis is 1 to 25% slippage, grade II is up to 50% slippage, grade III is up to 75% slippage, and grade IV is 76-100% slippage. If there is more than 100% slippage, it is known as spondyloptosis or grade V spondylolisthesis.  

Subclasses of isthmic spondylolisthesis are subtype A (stress fractures of the pars), subtype B (elongation of the pars without overt fracture), subtype C (acute fracture of the pars).

Subclasses of pathologic spondylolisthesis are subtype A (systemic causes) and subtype B (focal processes).

• Enhancing Healthcare Team Outcomes

An interprofessional team consisting of a specialty-trained orthopedic nurse, a physical therapist, and an orthopedic surgeon or neurosurgeon will provide the best outcome and long-term care of patients with degenerative spondylolisthesis. Chiropractors may also have involvement, as they may be the first to encounter the condition on X-rays. The treating clinician will decide on the management plan, and then have the other team members engaged - surgical cases with include the nursing staff in pre-, intra-, and post-operative care, and coordinating with PT for rehabilitation. In non-operative cases, the PT will keep the rest of the team informed of progress or lack thereof. The team should encourage weight loss as weight reduction may reduce symptoms and increase the quality of life. Interprofessional collaboration, as above, will drive patient outcomes to their best results. [Level 5]

• Review Questions
• Access free multiple choice questions on this topic.
• Comment on this article.

Lumbar Spine Sagittal CT of L5-S1, Grade II Spondylolisthesis Contributed by Christopher Gillis, MD, and Steven Tenny, MD

Disclosure: Steven Tenny declares no relevant financial relationships with ineligible companies.

Disclosure: Andrew Hanna declares no relevant financial relationships with ineligible companies.

Disclosure: Christopher Gillis declares no relevant financial relationships with ineligible companies.

This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.

• Cite this Page Tenny S, Hanna A, Gillis CC. Spondylolisthesis. [Updated 2023 May 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

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Spondylolisthesis is where one of the bones in your spine, known as a vertebra, slips forward. It can be painful, but there are treatments that can help.

It may happen anywhere along the spine, but is most common in the lower back.

Check if you have spondylolisthesis

Symptoms can include:

• pain in your lower back, which is often worse when standing or walking, and is often relieved when sitting or bending foward
• pain spreading to your bottom or thighs 
• tight hamstring (the muscles in the back of your thighs)
• pain, numbness or tingling spreading from the lower back down 1 leg) ( sciatica )

Sponylolisthesis does not always cause symptoms.

Spondylolisthesis is not the same as a slipped disc . This is when the tissue between the bones in your spine pushes out.

When to see your gp.

• you have lower back pain that does not go away after 3 to 4 weeks
• you have pain in your thighs or bottom that does not go away after 3 to 4 weeks
• you're finding it difficult to walk or stand up straight
• you're worried about the pain or you're struggling to cope
• you have pain, numbness and tingling down 1 leg for more than 3 or 4 weeks

What happens at your GP appointment

If you have symptoms of spondylolisthesis, the GP may examine your back.

They may also ask you to lie down and raise 1 leg straight up in the air. This is painful if you have tight hamstrings or sciatica caused by spondylolisthesis.

The GP may arrange an  X-ray  to see if a bone in your spine has slipped forward.

You may have other scans, such as an  MRI scan , if you have pain, numbness or weakness in your legs.

Treating spondylolisthesis

Treatments for spondylolisthesis depend on the symptoms you have and how severe they are.

Common treatments include:

• avoiding activities that make symptoms worse, such as bending, lifting, athletics and gymnastics
• taking anti-inflammatory painkillers such as ibuprofen or stronger painkillers on prescription
• steroid injections  in your back to relieve pain, numbness and tingling in your leg
• physiotherapy to strengthen and stretch the muscles in your lower back, tummy and legs

The GP may refer you to a physiotherapist, or you can refer yourself in some areas.

Waiting times for physiotherapy on the NHS can be long. You can also get it privately.

Find a physiotherapist on the Chartered Society of Physiotherapy website

Surgery for spondylolisthesis

The GP may refer you to a specialist for back surgery if other treatments do not work.

Types of surgery include:

• spinal fusion – the slipped bone (vertebra) is joined to the bone below with metal rods, screws and a bone graft
• lumbar decompression  – a procedure to relieve pressure on the compressed spinal nerves

The operation is done under  general anaesthetic , which means you will not be awake.

Recovery from surgery can take several weeks, but if often improves many of the symptoms of spondylolisthesis.

Talk to your surgeon about the risks and benefits of spinal surgery.

Causes of spondylolisthesis

Spondylolisthesis can:

• happen as you get older – the bones of the spine can weaken with age
• run in families
• be caused by a tiny crack in a bone (stress fracture) – this is more common in athletes and gymnasts

Last Updated: 29/11/2023 12:46:15

Spondylolisthesis: Definition, Causes, Symptoms, and Treatment

by Dave Harrison, MD • Last updated November 26, 2022

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What is Spondylolisthesis?

The spine is comprised of 33 bones, called vertebra , stacked on top of each other interspaced by discs . Spondylolisthesis is a condition where one vertebra slips forward or backwards relative to the vertebra below. More specifically, retrolisthesis is when the vertebra slips posteriorly or backwards, and anterolisthesis is when the vertebra slips anteriorly or forward.

Spondylosis vs Spondylolisthesis

Spondylosis and Spondylolisthesis are different conditions. They can be related but are not the same. Spondylosis refers to a fracture of a small bone, called the pars interarticularis, which connects the facet joint of the vertebra to the one below. This may lead to instability and ultimately slippage of the vertebra. Spondylolisthesis, on the other hand, refers to slippage of the vertebra in relation to the one below.

Types and Causes of Spondylolisthesis

There are several types of spondylolisthesis, often classified by their underlying cause:

Degenerative Spondylolisthesis

Degenerative spondylolisthesis is the most common cause, and is due to general wear and tear on the spine. Overtime, the bones and ligaments which hold the spine together may become weak and unstable.

Isthmic Spondylolisthesis

Isthmic spondylolisthesis is the result of another condition, called “ spondylosis “. Spondylosis refers to a fracture of a small bone, called the pars interarticularis, which connects the facet joint of the vertebra to the one below. If this interconnecting bone is broken, it can lead to slippage of the vertebra. This can sometimes occur during childhood or adolsence but go unnoticed until adulthood when degenerative changes cause worsening slippage.

Congenital Spondylolisthesis

Congenital spondylolisthesis occurs when the bones do not form correctly during fetal development

Traumatic Spondylolisthesis

Traumatic spondylolisthesis is the result of an injury such as a motor vehicle crash

Pathologic Spondyloslisthesis

Pathologic spondylolisthesis is when other disorders weaken the points of attachment in the spine. This includes osteoporosis, tumors, or infection that affect the bones and ligaments causing them to slip.

Iatrogenic Spondylolisthesis

Iatrogenic spondylolisthesis is the result of a prior surgery. Some operations of the spine, such as a laminectomy, may lead to instability. This can cause the vertebra to slip post operatively.

Spondylolisthesis Grades

Spondylolisthesis is classified based on the degree of slippage relative to the vertebra below

• Grade 1 : 1 – 25 % forward slip. This degree of slippage is usually asymptomatic.
• Grade 2: 26 – 50 % forward slip. May cause mild symptoms such as stiffness and pain in your lower back after physical activity, but it’s not severe enough to affect your everyday activities.
• Grade 3 : 51 – 75 % forward slip. May cause moderate symptoms such as pain after physical activity or sitting for long periods.
• Grade 4: 76 – 99% forward slip. May cause moderate to severe symptoms.
• Grade 5: Is when the vertebra has slipped completely of the spinal column. This is a severe condition known as “spondyloptysis”.

Symptoms of Spondylolisthesis

Spondylolisthesis can cause compression of spinal nerves and in severe cases, the spinal cord. The symptoms will depend on which vertebra is affected.

Cervical Spondylolisthesis (neck)

• Arm numbness or tingling
• Arm weakness

Lumbar Spondylolisthesis (low back)

• Buttock pain
• Leg numbness or tingling
• Leg weakness

Diagnosing Spondylolisthesis

Your doctor may order imaging tests to confirm the diagnosis and determine the severity of your spondylolisthesis. The most common imaging tests used include:

• X-rays : X-rays can show the alignment of the vertebrae and any signs of slippage.
• CT scan: A CT scan can provide detailed images of the bones and soft tissues in your back, allowing your doctor to see any damage or abnormalities.
• MRI: An MRI can show the spinal cord and nerves, as well as any herniated discs or other soft tissue abnormalities.

Treatments for Spondylolisthesis

Medications.

For those experiencing pain, oral medications are first line treatments. This includes non-steroidal anti-inflammatory medications (NSAIDs) such as ibuprofen, acetaminophen, or in severe cases opioids or muscle relaxants (with extreme caution). Topical medications such as lidocaine patches are also sometimes used.

Physical Therapy

Physical therapy can help improve mobility and strengthen muscles around your spine to stabilize your neck and lower back. You may also receive stretching exercises to improve flexibility and balance exercises to improve coordination.

Surgery is reserved for severe cases of spondylolisthesis in which there is a high degree of instability and symptoms of nerve compression.

In these cases a spinal fusion may be necessary. This surgery joins two or more vertebra together using rods and screws, in order to improve stability.

Reference s

• Alfieri A, Gazzeri R, Prell J, Röllinghoff M. The current management of lumbar spondylolisthesis. J Neurosurg Sci. 2013 Jun;57(2):103-13. PMID: 23676859.
• Stillerman CB, Schneider JH, Gruen JP. Evaluation and management of spondylolysis and spondylolisthesis. Clin Neurosurg. 1993;40:384-415. PMID: 8111991.

About the Author

Dave Harrison, MD

Dr. Harrison is a board certified Emergency Physician with a part time appointment at San Francisco General Medical Center and is an Assistant Clinical Professor-Volunteer at the UCSF School of Medicine. Dr. Harrison attended medical school at Tufts University and completed his Emergency Medicine residency at the University of Southern California. Dr. Harrison manages the editorial process for SpineInfo.com.

An Overview of Spondylolisthesis

What Is Spondylolisthesis?

Spondylolisthesis (pronounced spahn-duh-low-liss-thee-sus) is a condition in which one of the bones in your spine (the vertebrae) slips out of place and moves on top of the vertebra next to it.

It usually happens at the base of your spine (lumbar spondylolisthesis). When the slipped vertebra puts pressure on a nerve, it can cause pain in your lower back or legs.

Spondylolisthesis Symptoms

Sometimes, people with this condition don't notice anything is wrong. But you can have symptoms that include:

• Lower back pain
• Muscle tightness and stiffness
• Pain in your buttocks
• Pain that spreads down your legs (due to pressure on nerve roots)
• Pain that gets worse when you move around
• Tight hamstrings (muscles in the back of your thighs)
• Trouble standing or walking

Spondylolisthesis vs. Spondylolysis

Spondylolysis (pronounced spahn-duh-loll-iss-us) and spondylolisthesis are different conditions of the spine, though they're sometimes related. Both conditions cause pain in your lower back .

Spondylolysis is a weakness or small fracture (crack) in one of your vertebrae. This usually affects your lower back, but it can also happen in the middle of your back or your neck. It's most often found in kids and teens, especially those involved in sports that repeatedly overstretch the lower spine, like football or gymnastics.

It's not uncommon for people with spondylolysis to also have spondylolisthesis. That's because the weakness or fracture in your vertebra may cause it to move out of place.

Types of Spondylolisthesis

Doctors divide this condition into six main types, determined by cause.

Degenerative spondylolisthesis: This is the most common type. As people age, the disks that cushion vertebrae can become worn, dry out, and get thinner. This makes it easier for the vertebra to slip out of place.

Isthmic spondylolisthesis: This type is caused by spondylosis. A crack in the vertebra can lead it to slip backward, forward, or over a bone below. It may affect kids and teens who do gymnastics, do weightlifting, or play football because they repeatedly overextend their lower backs. But it also sometimes happens when you're born with vertebrae whose bone is thinner than usual.

Congenital spondylolisthesis: Also known as dysplastic spondylolisthesis, this happens when your vertebrae are aligned incorrectly due to a birth defect.

Traumatic spondylolisthesis: In this type, an injury (trauma) to the spine causes the vertebra to move out of place.

Pathological spondylolisthesis: This type is caused by another spine condition, such as osteoporosis or a spinal tumor.

Postsurgical spondylolisthesis: Also called iatrogenic spondylolisthesis, this happens when a vertebra slips out of place after spinal surgery.

Grades of Spondylolisthesis

Your doctor may give your spondylolisthesis a grade based on how serious it is. The most common grading system is called Meyerding's classification and includes:

• Grade I : The most common grade, this is defined as 1%-25% slippage of the vertebra
• Grade II : Up to 50% slippage of the vertebra
• Grade III : Up to 75% slippage
• Grade IV : 76%-100% slippage
• Grade V : More than 100% slippage, also known as spondyloptosis

Grades I and II are considered low grade. Grades III and up are considered high grade.

Spondylolisthesis Causes and Risk Factors

Causes of spondylolisthesis include:

• Wear and tear with age
• Birth defects
• Spondylolysis
• Injury to the spine
• Another condition such as a spinal tumor or osteoporosis
• Spinal surgery

You're more likely to get this condition if you:

• Take part in sports that put stress on your spine
• Were born with thinner areas of vertebrae that are prone to breaking and slipping
• Are 50 or older
• Have a degenerative spinal condition

Spondylolisthesis Diagnosis

If your doctor thinks you might have this condition, they'll ask about your symptoms and run imaging tests to see if a vertebra is out of place. These tests may include:

These tests can also help your doctor determine a grade for your spondylolisthesis.

Spondylolisthesis Treatments

The treatment you'll need depends on what grade of spondylolisthesis you have, as well as your age, symptoms, and your medical history. Low grade can usually be treated with physical therapy or medications. With high grade, you may need surgery, especially if you're in a lot of pain.

Nonsurgical treatment options include:

• Rest : You may need to take some time off from sports and other vigorous activities.
• Medications : Your doctor may recommend over-the-counter anti-inflammatory medicines to relieve your pain, such as ibuprofen or naproxen.
• Injections : Steroid shots in the area where you have pain can bring relief.
• Physical therapy : Daily exercises that stretch and strengthen your supportive abdominal and lower back muscles can lower your pain.
• Braces : For children with fractures in the vertebrae (spondylolysis), a back brace can restrict movement so the fractures can heal.

Spondylolisthesis Surgery

If you have high-grade spondylolisthesis or if you still have serious pain and disability after nonsurgical treatments, you may need surgery. This usually means spinal decompression, often along with spinal fusion.

Spinal surgery is always done under general anesthesia , which means you're asleep during the operation.

Spinal decompression: Decompression lessens the pressure on the nerves in your spine to relieve pain. There are several techniques your surgeon can use to give your nerves more room. They may remove bone from your spine, take out part or all of a disk, or make the opening in your spinal canal larger. Your surgeon might need to use all these methods during your surgery.

Spinal fusion: In spinal fusion, the doctor joins, or fuses, the affected vertebrae together to prevent them from slipping again. After this surgery, you may have a bit less flexibility in your spine.

Pars repair: This surgery repairs fractures in the vertebrae using small wires or screws. Sometimes, a bone graft is used to reinforce the fracture so it can heal better.

After spinal surgery, you'll likely need to stay in the hospital for at least a day. Most people can go home within a week. You may be able to stand or even walk the day after the operation. You may go home with pain medication to ensure that your recovery is as easy as possible.

You'll need to limit physical activity for 8-10 weeks after your surgery so your spine can heal. But you should still move around and even walk every day. This can make your recovery go faster and help keep complications at bay.

Around 10-12 weeks after your surgery, you'll start physical therapy to stretch and strengthen your muscles and help you move more easily. Ideally, you should have physical therapy for a year.

For the first year after your surgery, you'll need to see your surgeon about every 3 months. You'll likely have X-rays taken at these follow-ups to make sure your spine is healing well.

Spondylolisthesis Complications

Serious spondylolisthesis sometimes leads to another condition called cauda equina syndrome . This is a serious condition in which nerve roots in part of your lower back called the cauda equina get compressed. It can cause you to lose feeling in your legs. It also can affect your bladder.

This is a medical emergency. If left untreated, cauda equina syndrome can lead to a loss of bladder control and paralysis.

See your doctor if you:

• Have trouble controlling your bladder or bowels
• Notice numbness or a strange sensation between your legs or on your buttocks, inner thighs, backs of your legs, feet, or heels
• Have pain or weakness in a leg or both legs that may cause stumbling

The symptoms may come on slowly and vary in how serious they are.

Spondylolisthesis Outlook

For most people, rest and nonsurgical treatments bring long-term relief within several weeks. But sometimes, spondylolisthesis comes back again after treatment. This happens more often when it was a higher grade.

If you've had surgery, you'll most likely do well afterward. Most people get back to normal activities within a few months. But your spine may not be as flexible as it was before.

Spondylolisthesis is when one of your vertebrae moves out of place. This sometimes leads to back pain and other symptoms. It can be usually treated with rest, medication, and/or physical therapy. But serious cases may require surgery.

Spondylolisthesis FAQs

What is the main cause of spondylolisthesis?

In adults, it most often happens when cartilage and bones in the spine become worn from conditions such as arthritis. It's more common in people age 50 and older. In kids and teens, the most common causes are either a spinal birth defect or injury to the spine.

Is spondylolisthesis a serious condition?

For most people, it's not serious. Many people have few symptoms or no symptoms at all. It's only a problem when it causes pain or limits your ability to move. If that happens, you'll need to see a doctor for treatment.

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Spondylolisthesis

Spondylolisthesis is where one of the bones in your spine, called a vertebra, slips forward. It can be painful, but there are treatments that can help.

It may happen anywhere along the spine, but is most common in the lower back.

Check if you have spondylolisthesis

The main symptoms of spondylolisthesis include:

• pain in your lower back, often worse when standing or walking and relieved when sitting or bending forward
• pain spreading to your bottom or thighs
• tight hamstrings (the muscles in the back of your thighs)
• pain, numbness or tingling spreading from your lower back down 1 leg ( sciatica )

Spondylolisthesis does not always cause symptoms.

Spondylolisthesis is not the same as a slipped disc . This is when the tissue between the bones in your spine pushes out.

See a GP if:

• you have lower back pain that does not go away after 3 to 4 weeks
• you have pain in your thighs or bottom that does not go away after 3 to 4 weeks
• you're finding it difficult to walk or stand up straight
• you're worried about the pain or you're struggling to cope
• you have pain, numbness and tingling down 1 leg for more than 3 or 4 weeks

What happens at your GP appointment

If you have symptoms of spondylolisthesis, the GP may examine your back.

They may also ask you to lie down and raise 1 leg straight up in the air. This is painful if you have tight hamstrings or sciatica caused by spondylolisthesis.

The GP may arrange an X-ray to see if a bone in your spine has slipped forward.

You may have other scans, such as an MRI scan , if you have pain, numbness or weakness in your legs.

Treatments for spondylolisthesis

Treatments for spondylolisthesis depend on the symptoms you have and how severe they are.

Common treatments include:

• avoiding activities that make symptoms worse, such as bending, lifting, athletics and gymnastics
• taking anti-inflammatory painkillers such as ibuprofen or stronger painkillers on prescription
• steroid injections in your back to relieve pain, numbness and tingling in your leg
• physiotherapy to strengthen and stretch the muscles in your lower back, tummy and legs

The GP may refer you to a physiotherapist, or you can refer yourself in some areas.

Waiting times for physiotherapy on the NHS can be long. You can also get it privately.

Find a physiotherapist on the Chartered Society of Physiotherapy website

The GP may refer you to a specialist for back surgery if other treatments do not work.

Types of surgery include:

• spinal fusion – the slipped bone (vertebra) is joined to the bone below with metal rods, screws and a bone graft
• lumbar decompression – a procedure to relieve pressure on the compressed spinal nerves

The operation is done under general anaesthetic , which means you will not be awake.

Recovery from surgery can take several weeks, but if often improves many of the symptoms of spondylolisthesis.

Talk to your surgeon about the risks and benefits of spinal surgery.

Causes of spondylolisthesis

Spondylolisthesis can:

• happen as you get older – the bones of the spine can weaken with age
• run in families
• be caused by a tiny crack in a bone (stress fracture) – this is more common in athletes and gymnasts

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Spondylolisthesis: Understanding Causes, Symptoms & Treatment

Are you experiencing lower back pain that won't go away? Have you or a loved one recently been diagnosed with spondylolisthesis? If so, you're not alone. Spondylolisthesis is a common condition that affects the spine, and understanding its causes, symptoms, and treatment is crucial for managing and improving your quality of life. 

This blog post will explore everything you need about spondylolisthesis, including its various forms, underlying causes, and effective treatment options. So, whether you're dealing with this condition or simply looking to educate yourself on this joint spine issue, keep reading to understand better spondylolisthesis and how to address it effectively.

What is Spondylolisthesis? 

Spondylolisthesis is a common condition that affects the spine and can cause discomfort and pain for those with it. It occurs when one vertebra (bone in the spine) slips forward over another vertebra, causing the spinal column to become misaligned. This condition can affect people of all ages, but it is most commonly seen in adults over 50 .

What is the root cause of Spondylolisthesis?

The most common cause of spondylolisthesis is a fracture or defect in the pars interarticularis , a small bony section of the vertebra. This fracture can be caused by repetitive stress due to sports or activities that pressure the spine, such as weightlifting, gymnastics, or football. It can also happen due to congenital conditions or degenerative diseases like arthritis. Sometimes, spondylolisthesis can be caused by sudden trauma, such as a car accident or a fall.

What are the signs and symptoms of Spondylolisthesis?

The symptoms of spondylolisthesis vary depending on the severity of the condition. In mild cases, there may be no noticeable symptoms, but as the condition progresses, symptoms may include:

• Lower back pain
• Muscle spasms in the back
• Stiffness in the back
• Numbness or tingling in the legs
• Difficulty standing or walking
• Decreased range of motion in the back
• Weakness in the legs

How do you stop spondylolisthesis from progressing?

How exactly do you stop spondylolisthesis from worsening? There are practical strategies for managing and halting the progression of spondylolisthesis. Get ready to take control of your spinal health and stop spondylolisthesis in its tracks.

• Exercise regularly – Regular exercise helps to strengthen the muscles in your back and abdomen, providing better support for your spine. However, if you have spondylolisthesis, some exercises may be harmful. Consult a physical therapist to create a safe, individualized exercise plan for your condition.
• Avoid high-impact activities – Jumping and landing on the feet, such as running or basketball, can put additional stress on the spine. Instead, opt for low-impact exercises like swimming or cycling.
• Practice good posture – Poor posture can contribute to spondylolisthesis. Make a conscious effort to maintain good posture throughout the day, whether sitting, standing, or bending over. Consider using a lumbar support cushion if you spend much time sitting.
• Lose weigh t – Being overweight stresses the spine, which can worsen spondylolisthesis. Maintaining a healthy weight can help ease symptoms and stop the condition from progressing.
• Avoid lifting heavy objects – Putting strain on the lower back can worsen spondylolisthesis. If you need to lift heavy objects, use proper lifting techniques, such as bending your knees and keeping your back straight.
• Consider chiropractic care – Chiropractic manipulation and adjustments can help improve joint function and decrease pain in spondylolisthesis patients.
• Seek medical treatment – If you have persistent symptoms of spondylolisthesis, it's crucial to seek medical treatment. Your doctor may recommend physical therapy, pain medication, or in severe cases, surgery.

What are the 5 stages of spondylolisthesis?

Understanding the stages of spondylolisthesis is essential to identify its severity and manage it effectively. These are the five stages of spondylolisthesis and the accompanying symptoms.

Stage 1: Grade 1 Spondylolisthesis

The first stage of spondylolisthesis is also known as mild spondylolisthesis and is characterized by the slippage of less than 25% of one vertebra over another. In this stage, the symptoms may be minimal, and most people may not experience any. However, some common symptoms of grade 1 spondylolisthesis include mild back pain, stiffness, and muscle tightness in the lower back.

Stage 2: Grade 2 Spondylolisthesis

Grade 2 spondylolisthesis is characterized by the slippage of 26% to 50% of one vertebra over another. At this stage, the symptoms can become more noticeable, including increased back pain, numbness or tingling in the legs or feet, and difficulty standing or walking for extended periods. This stage may also lead to changes in posture and decreased flexibility in the lower back.

Stage 3: Grade 3 Spondylolisthesis

In this stage, the slippage increases to 51% to 75% of one vertebra over another. At this point, the spinal deformity may become apparent. Patients may experience severe back pain that radiates to the hips and legs, making it difficult to perform daily activities. Nerve compression is also standard in this stage, leading to symptoms like weakness, numbness, and tingling in the legs.

Stage 4: Grade 4 Spondylolisthesis

Grade 4 spondylolisthesis is characterized by the slippage of more than 75% of one vertebra over another. This stage can be severely debilitating, causing extreme back pain, nerve compression, and even difficulty in controlling bladder and bowel movements. Patients may also experience weakness and numbness in the legs, making it challenging to walk or stand for extended periods.

Stage 5: Grade 5 Spondylolisthesis

The final stage of spondylolisthesis, grade 5, is also known as spondyloptosis. In this stage, the slippage is more than 100% of one vertebra over another, meaning the vertebra has completely slipped off the one below it. At this point, the spinal deformity is severe and can lead to life-altering symptoms, including severe back pain, nerve damage, and loss of motor control in the legs.

Treatment options for Spondylolisthesis

Various treatment options for spondylolisthesis can help manage and relieve its symptoms. Let’s explore these treatment options and how they can help those with spondylolisthesis.

• Physical therapy: 

Physical therapy is often the first line of treatment for spondylolisthesis. A physical therapist will work with the patient to strengthen the muscles in the back and abdomen, which can help stabilize the spine and prevent further slippage. They will also teach the patient proper posture and body mechanics to reduce pressure on the affected area. Physical therapy can also include exercises to increase flexibility and range of motion, which can help alleviate pain and stiffness.

• Medications:  

Over-the-counter pain relievers such as ibuprofen and acetaminophen can help manage the pain caused by spondylolisthesis. Sometimes, a doctor may prescribe more vital pain medication or muscle relaxants if the pain is severe. However, these medications should only be used under the supervision of a doctor and are not a long-term solution for managing the condition.

• Bracing:  

In some cases, a back brace may be recommended to provide support and stability to the affected area. This can help alleviate pain and prevent further slippage. It is crucial to work with a physical therapist to ensure the proper fit and usage of the brace.

• Steroid injections:  

If other treatment options do not provide enough relief, a doctor may recommend steroid injections. These injections can help reduce inflammation and pain in the affected area. They are generally used as a short-term solution and may need to be repeated periodically.

• Surgery: 

In severe cases of spondylolisthesis, surgery may be required. The most common surgery for this condition is spinal fusion, where the affected vertebrae are fused together to prevent slippage. This surgery can help alleviate pain and prevent further damage to the spine and nerves.

Get lasting relief from Spondylolisthesis!

Ready to take control of your Spondylolisthesis and find lasting relief? Look no further than Neuro Spine & Pain Center - your top choice for comprehensive treatment and expert care for Miami pain management .

Our team of renowned spine specialists in Miami understands the complexity of Spondylolisthesis and is dedicated to creating personalized treatment plans to address its underlying causes. From advanced imaging techniques to cutting-edge therapies, we have the tools to help you overcome this condition and live your life to the fullest. 

Don't let Spondylolisthesis hold you back any longer, schedule a consultation with our experts today and let us guide you towards a pain-free and active lifestyle.

The material on this site is for informational purposes only and DOES NOT CONSTITUTE THE PROVIDING OF MEDICAL ADVICE, and is not intended to be a substitute for independent professional medical judgment, advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions or concerns you may have regarding your health.

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• Conditions >

Spondylolisthesis

Persistent back pain and numbness down your legs may be caused by spondylolisthesis, where one of the bones in your spine has slipped out of position.

By Wallace Health I Medically reviewed by Adrian Roberts. Page last reviewed: October 2018 I Next review due: October 2023

What is spondylolisthesis?

This usually occurs in your lower back but can also occur in your neck or mid to upper back. A slipped vertebra can put pressure on the nerves in your spinal canal, which connect your brain and your body. This can cause pain, pinching, numbness and weakness, usually in your lower back and legs. 

Spondylolisthesis is not the same as a slipped disc — a slipped disc refers to one of the fluid-filled cushions between your vertebrae slipping out of position.

Spondylolisthesis is pronounced spohn-di-low-less-THEE-sis. In Greek, spondylos means spine or vertebra and listhesis means movement, sliding or slipping.

Is spondylolisthesis the same as spondylolysis?

Spondylolysis and spondylolisthesis both cause lower back pain but they are not the same condition. 

Spondylolysis is caused by a bone defect in your spine, which is usually caused by a stress fracture. It is common in young athletes.

Spondylolisthesis is caused by a vertebra slipping out of place and putting pressure on the vertebra below it as well as the nerves that run through the spinal canal. 

However, spondylolysis can cause spondylolisthesis if the stress fracture results in the vertebra slipping.

How to tell if you have spondylolisthesis

Spondylolisthesis is most common in your lower back and might cause these symptoms:

• Lower back pain which may get worse during activity
• Pain, numbness or pins and needles down your legs (these symptoms are known as sciatica )
• Tight hamstrings
• Curvature or bulging of the spine

If you have difficulty walking and feel unsteady on your feet, this may also be a sign.

It's possible to have spondylolisthesis without any of these symptoms.

Talk to your doctor if you’re concerned about symptoms

You can book an appointment  with a Spire private GP today.

Book an appointment

Diagnosis and tests for spondylolisthesis

You should see your GP if: 

• You have persistent back pain or stiffness
• You have persistent pain in your buttocks or thighs
• Your back curves outwards

Your GP may examine your back, although spondylolisthesis doesn’t usually cause any visible symptoms. They may also examine your limbs to see the amount of movement and pain you have. This may include a straight leg test — this involves lying on your back while your GP holds your foot and gently lifts your leg up while you keep your knee straight.

You may need an X-ray while standing to see if you have a slipped vertebra in your spine or a spinal fracture. If you have numbness, weakness or tingling in your legs, you may also need an MRI scan or CT scan to detect if your slipped vertebra is compressing a nerve.

Causes of spondylolisthesis

There are different causes of spondylolisthesis:

• A birth defect in a vertebra — this can cause the vertebra to slip forward 
• A sudden injury, such as a fracture from a car accident
• An infection or tumour that causes a bone abnormality
• Gradual wear and tear of the vertebrae and cartilage ( osteoarthritis ) — this is more common in older people
• Repetitive trauma, such as heavy weight lifting or gymnastics, which causes a defect in your spine to develop
• Spinal stenosis

Types of spondylolisthesis

The three most common types of spondylolisthesis are:

• Congenital spondylolisthesis — a defect in the formation of a baby's spine before birth that increases the risk of a vertebra slipping in later life
• Degenerative spondylolisthesis — the most common type of spondylolisthesis caused by thinning of the vertebral discs (fluid-filled cushions that sit between the vertebrae) as you get older; the discs thin because they lose water and thinner discs increase the chance of a vertebra slipping out of place
• Isthmic spondylolisthesis — caused by spondylolysis ie a defect of the spine usually caused by a stress fracture

Less common types of spondylolisthesis include:

• Pathological spondylolisthesis — caused by a disease (eg osteoporosis) or a tumour
• Post-surgical spondylolisthesis — caused by spinal surgery 
• Traumatic spondylolisthesis — caused by an injury to the spine

Who is at risk of spondylolisthesis?

Your risk of developing spondylolisthesis is greater if: 

• You are a young athlete — children and teenagers who play sports that stretch the lower spine eg football or gymnastics; spondylolisthesis usually occurs during a growth spurt and is the most common cause of back pain in teenagers
• You are aged over 50 — degenerative spondylolisthesis is more likely as you get older as it is caused by wear and tear of the spine over time, although it also has a genetic component
• You are born with part of your vertebra called the pars interarticularis being thinner than normal — the pars interarticularis connects the facet joints which link a vertebra to the vertebrae above and below it so your spine can function as a unit; a thinner pars interarticularis is more likely to fracture and cause the vertebra to slip
• You have another degenerative spinal condition

Common treatments for spondylolisthesis

The treatment you receive will depend on the severity of your symptoms and how much they are affecting your quality of life. In most cases, your doctor will recommend non-surgical treatments first, such as: 

• Anti-inflammatory painkillers eg ibuprofen — if over-the-counter medications are not enough to reduce your pain, your doctor may prescribe stronger painkillers
• Bracing — usually only for children
• Steroid injections to relieve inflammation and pain — this includes: 
• Facet joint injections  
• Injections around the nerve that is being compressed by the slipped vertebra
• Physiotherapy — targeted daily exercises to stretch and strengthen your abdomen, hamstrings and lower back; this will help reduce your pain and increase your range of motion
• Rest — avoiding activities, such as bending, lifting, athletics and other sports, for a short period of time

These treatments provide temporary relief and during this time, your symptoms may go away on their own. 

Your doctor will usually only recommend back surgery if:

• A nerve is compressed
• Non-surgical treatments have not worked
• Your symptoms are persistent and severe

The type of back surgery you have will depend on what type of spondylolisthesis you have. This could be: 

• Decompression surgery to remove part of your spine to relieve pressure
• Surgery to fuse the slipped vertebra to the vertebrae next to it using metal rods and screws and a piece of your own bone — this will keep the slipped vertebra in place
• Surgery to remove the vertebral disc between two vertebrae and replace it with a metal cage containing a bone graft — this will hold the vertebrae apart

These are major surgeries and you will need to stay in hospital for up to a week. It will take months for a full recovery.  

Surgery usually relieves many spondylolisthesis symptoms, including pain and numbness in the legs. However, there are risks of complications, including: 

• Damage to the spinal nerves or spinal cord — this can cause ongoing symptoms of numbness or weakness in the legs and in rare cases, bowel incontinence , urinary incontinence or paralysis
• Deep vein thrombosis (DVT) — a blood clot in one of the deep veins in your leg 
• Infection at the surgical site 

Your doctor or surgeon will discuss the details of your surgical options and the risks involved before you make a decision. 

Will spondylolisthesis come back?

In most cases, pain caused by spondylolisthesis goes away after recovering from spondylolisthesis surgery. Over time, you can return to your normal activities and regain full function and movement.

Spondylolisthesis complications

Spondylolisthesis can cause cauda equina syndrome. At the base of your spinal cord is a collection of nerves called the cauda equina. In cauda equina syndrome, these nerves are compressed, which can cause loss of feeling in your legs and bladder problems. It is a medical emergency. If it is not treated it can cause urinary incontinence and paralysis.

How can I reduce my risk of spondylolisthesis?

• Eat a healthy, balanced diet to maintain strong bones
• Maintain a healthy weight — being overweight or obese puts extra strain on your spine
• Perform regular exercises to strengthen your back and abdomen

Spondylolisthesis outlook

In some cases, spondylolisthesis comes back but this is usually if your first instance of spondylolisthesis was severe ie your vertebra moved considerably out of its normal position. 

However, after spondylolisthesis surgery, most people return to normal activities after a recovery period, although your spine will be less flexible.

Frequently asked questions

How do you fix spondylolisthesis?

Spondylolisthesis can be treated without surgery by using anti-inflammatory painkillers, physiotherapy and with rest. In some cases, you may need steroid injections. However, if these treatments are not effective, back surgery may be recommended.

Is spondylolisthesis serious?

Spondylolisthesis can be mild, moderate or severe. Severe cases of spondylolisthesis can be serious as they may lead to cauda equina syndrome, which is a medical emergency — if this condition is not treated it can cause urinary incontinence and paralysis. Even moderate cases, over time, if left untreated, can cause nerve damage if a nerve is compressed. You should therefore see your GP if you are concerned that you have spondylolisthesis as there are effective treatments.

What is the difference between spondylolysis and spondylolisthesis?

Both conditions can cause lower back pain. However, the underlying cause is different. Spondylolisthesis is caused by a bone in your spine (vertebra) slipping out of place, whereas spondylolysis is caused by a defect in your vertebra, which is usually caused by a stress fracture.

Is walking bad for spondylolisthesis?

Walking is not bad for spondylolisthesis as long as it doesn’t worsen your pain. Walking and other exercises that do not bend or strain your back can help strengthen your back and abdominal muscles, which can reduce your pain and improve your range of motion.

Can chiropractic help spondylolisthesis?

A chiropractor can’t fix your spondylolisthesis — they can’t push the slipped vertebra back into place. However, they can improve your range of movement and reduce your pain by focusing on the rest of your spine.

What should you not do with spondylolisthesis?

You should not take part in activities that strain or stretch your back, such as athletics, bending, lifting and football.

Can you become paralyzed from spondylolisthesis?

If a nerve is compressed, over time, spondylolisthesis can cause nerve damage, which may lead to paralysis. In some cases, spondylolisthesis can cause cauda equina syndrome — another spinal condition that is a medical emergency because if it is left untreated there is a high risk of paralysis.

Can you live with spondylolisthesis without surgery?

Yes, in many cases, spondylolisthesis can be effectively treated with non-surgical interventions, such as physiotherapy, resting your back, taking painkillers and/or steroid injections.

How should I sleep with spondylolisthesis?

Sleeping on your back in a reclining position can help reduce the pressure on your spine caused by the slipped vertebra ie sleeping propped up on several pillows.

When should you have surgery for spondylolisthesis?

If you have tried non-surgical treatments for spondylolisthesis (rest, physiotherapy, painkillers and steroid injections) and they have not worked, then surgery may be recommended. Your doctor may also recommend surgery if a nerve is compressed or your symptoms are persistent and severe.

Can you live a normal life after spinal fusion?

After a period of recovery, you can return to your normal activities. However, you will have reduced flexibility in the area of your spine where the vertebrae were fused.

Can spondylolisthesis cause bowel problems?

If spondylolisthesis is causing severe compression of a nerve, this can cause bowel incontinence.

Does spondylolisthesis get worse over time?

This depends on the severity and type of spondylolisthesis you have. Over time, symptoms of mild spondylolisthesis may go away on their own. However, in other cases, symptoms can get worse eg if a nerve is compressed or if you have degenerative spondylolisthesis.

https://www.nhs.uk/conditions/spondylolisthesis/

http://www.britscoliosissoc.org.uk/patient-information/spondylolisthesis  

https://orthoinfo.aaos.org/en/diseases--conditions/spondylolysis-and-spondylolisthesis/  

https://my.clevelandclinic.org/health/diseases/10302-spondylolisthesis  

https://www.webmd.com/back-pain/guide/pain-management-spondylolisthesis

https://patient.info/doctor/spondylolysis-and-spondylolisthesis

https://spinalresearch.com.au/6735-2/

https://www.healthline.com/health/healthy-sleep/best-sleeping-position-for-lower-back-pain

Related topics

Related treatments:

• Back surgery (spinal surgery)
• Facet joint injections
• Physiotherapy from Spire

Related symptoms:

Related conditions:

• Degenerative Spondylolisthesis

By: Marco Funiciello, DO, Physiatrist

Peer-Reviewed

Spondylolisthesis is Latin for "slipped vertebral body," and is diagnosed when one vertebra slips forward over the one below. 

Degenerative spondylolisthesis may occur as part of the normal aging process of the spine. It may alter normal spinal alignment. 1 Akkawi I, Zmerly H. Degenerative Spondylolisthesis: A Narrative Review. Acta Biomed. 2022 Jan 19;92(6):e2021313. doi: 10.23750/abm.v92i6.10526. PMID: 35075090; PMCID: PMC8823594. , 2 Cushnie D, Johnstone R, Urquhart JC, Gurr KR, Bailey SI, Bailey CS. Quality of Life and Slip Progression in Degenerative Spondylolisthesis Treated Nonoperatively. Spine (Phila Pa 1976). 2018;43(10):E574-E579. doi:10.1097/BRS.0000000000002429

Degenerative spondylolisthesis typically occurs in the lumbar spine (low back). In most cases, the L4-L5 spinal segment is affected, followed by the L3-L4 and L5-S1 spinal segments. 1 Akkawi I, Zmerly H. Degenerative Spondylolisthesis: A Narrative Review. Acta Biomed. 2022 Jan 19;92(6):e2021313. doi: 10.23750/abm.v92i6.10526. PMID: 35075090; PMCID: PMC8823594.

Show Transcript

Degenerative spondylolisthesis is a condition in which one vertebral body slips forward on top of the vertebral body below it, as a result of aging processes that weaken the spine. As a person ages, spinal discs tend to weaken and dry out, leading to arthritis that weakens the ligaments and joints of the spine.

As the facet joints at the back of the spine weaken, a vertebra may slip forward over the one below it. Degenerative spondylolisthesis occurs most frequently at the L4-L5 or L3-L4 segments of the spine, though it can occur at one to three levels simultaneously, and rarely in the cervical spine.

Many people do not have symptoms from degenerative spondylolisthesis. The most common source of pain from degenerative spondylolisthesis comes from a narrowing of the spinal canal. When the vertebra slips forward, it can compress nerve roots and cause low back pain or radiating pain.

Patients may also have a tired feeling in the legs or difficulty walking as a result of pinched nerves or tight hamstrings. Degenerative spondylolisthesis is linked to a number of other conditions, including arthritis and degenerative disc disease. Understanding its causes and symptoms is important to developing a treatment program with a doctor.

In This Article:

• Degenerative Spondylolisthesis Symptoms
• Degenerative Spondylolisthesis Treatment
• Surgery for Degenerative Spondylolisthesis

Degenerative Spondylolisthesis Video

4 most common causes of degenerative spondylolisthesis.

Age-related changes, like facet joint arthritis, may lead to degenerative spondylolisthesis.

Degenerative spondylolisthesis is attributed to age-related changes that can disrupt spinal alignment. 

The specific changes include 1 Akkawi I, Zmerly H. Degenerative Spondylolisthesis: A Narrative Review. Acta Biomed. 2022 Jan 19;92(6):e2021313. doi: 10.23750/abm.v92i6.10526. PMID: 35075090; PMCID: PMC8823594. , 3 García-Ramos CL, Valenzuela-González J, Baeza-Álvarez VB, Rosales-Olivarez LM, Alpizar-Aguirre A, Reyes-Sánchez A. Degenerative spondylolisthesis I: general principles. Acta Ortop Mex. 2020;34(5):324-328. doi:10.35366/97997 :

• Degeneration of the spinal discs
• Loss of resilience and strength in the ligaments responsible for spinal stability
• Osteoarthritis of the facet joints that connect the vertebrae, resulting in less support for the spinal segment
• Inadequate muscle stabilization

Less commonly, pregnancy and participating in sports may accelerate degenerative changes in the spine, leading to spondylolisthesis. 4 Wang YXJ, Káplár Z, Deng M, Leung JCS. Lumbar degenerative spondylolisthesis epidemiology: A systematic review with a focus on gender-specific and age-specific prevalence. J Orthop Translat. 2016;11:39-52. Published 2016 Dec 1. doi:10.1016/j.jot.2016.11.001

How Degenerative Spondylolisthesis Develops: The Role of the 3-Joint Complex

Spondylolisthesis occurs as a result of spinal motion segment degeneration.

Spondylolisthesis develops due to degeneration at a spinal motion segment, which comprises a 3-joint complex. 5 Bernard F, Mazerand E, Gallet C, Troude L, Fuentes S. History of degenerative spondylolisthesis: From anatomical description to surgical management. Neurochirurgie. 2019;65(2-3):75-82. doi:10.1016/j.neuchi.2019.03.006 This 3-joint complex includes:

• A disc in the front, which acts as a shock absorber between adjacent vertebrae (bones that make up the spinal column)
• A pair of facet joints in the back, which allow limited motion. The facet joints may bear weight and limit spinal forward bending (flexion), backward bending (extension), rotation, and side-to-side motion.

Aging-related degeneration of the facets and discs may make them less able to bear loads, resulting in vertebral slippage in load-bearing segments of the lower spine. 3 García-Ramos CL, Valenzuela-González J, Baeza-Álvarez VB, Rosales-Olivarez LM, Alpizar-Aguirre A, Reyes-Sánchez A. Degenerative spondylolisthesis I: general principles. Acta Ortop Mex. 2020;34(5):324-328. doi:10.35366/97997

2 Types of Vertebral Slippage in Degenerative Spondylolisthesis

Vertebral slippage can occur symmetrically when both facets are equally affected.

Vertebral slippage in degenerative spondylolisthesis can happen in two ways 3 García-Ramos CL, Valenzuela-González J, Baeza-Álvarez VB, Rosales-Olivarez LM, Alpizar-Aguirre A, Reyes-Sánchez A. Degenerative spondylolisthesis I: general principles. Acta Ortop Mex. 2020;34(5):324-328. doi:10.35366/97997 :

• Symmetrically, if both facets are equally affected and degenerated. In this case, the vertebra slips forward horizontally in a symmetrical manner.
• Asymmetrically, where one facet is more degenerated than the other, causing the slippage to occur asymmetrically, which usually results in rotation. 

In either case, the spinal disc also slips forward along with the vertebra. 3 García-Ramos CL, Valenzuela-González J, Baeza-Álvarez VB, Rosales-Olivarez LM, Alpizar-Aguirre A, Reyes-Sánchez A. Degenerative spondylolisthesis I: general principles. Acta Ortop Mex. 2020;34(5):324-328. doi:10.35366/97997

Degenerative spondylolisthesis commonly occurs in the low back and is relatively rare in other parts of the spine. The condition may occur in the neck (cervical spondylolisthesis) due to degenerative changes in the cervical facet joints.

How Degenerative Spondylolisthesis Causes Pain

In degenerative spondylolisthesis, pain occurs due to neural compression from spinal stenosis.

Degenerative spondylolisthesis causes pain through one or more of the following processes 3 García-Ramos CL, Valenzuela-González J, Baeza-Álvarez VB, Rosales-Olivarez LM, Alpizar-Aguirre A, Reyes-Sánchez A. Degenerative spondylolisthesis I: general principles. Acta Ortop Mex. 2020;34(5):324-328. doi:10.35366/97997 :

• Joint pain: Degeneration of facet joints causes inflammation of the cartilaginous facet joint lining
• Soft tissue pain: Tension within the capsule and ligaments that surround the facet joints as the vertebra slips
• Muscle pain: Spasm of the muscles that support the affected spinal segment
• Stenosis pain: Narrowing of the central canal ( spinal stenosis ) and/or intervertebral foramen (foraminal stenosis) causing compression of the neural elements

These processes can result in some combination of localized back pain, sciatica , lumbar radiculopathy , and/or neurogenic claudication. 4 Wang YXJ, Káplár Z, Deng M, Leung JCS. Lumbar degenerative spondylolisthesis epidemiology: A systematic review with a focus on gender-specific and age-specific prevalence. J Orthop Translat. 2016;11:39-52. Published 2016 Dec 1. doi:10.1016/j.jot.2016.11.001

Hallmark Symptoms and Signs of Degenerative Spondylolisthesis

Back pain radiating to the buttocks is a common symptom of degenerative spondylolisthesis.

There’s a wide variation of spondylolisthesis symptoms. In general, the typical symptoms include some combination of 6 Matz PG, Meagher RJ, Lamer T, et al. North American Spine Society. Clinical Guidelines for Multidisciplinary Spine Care. Diagnosis and Treatment of Degenerative Lumbar Spondylolisthesis. 2nd ed; 2016. :

• Occasional back pain that comes and goes with increased activity
• Chronic low back pain 
• Back pain with or without buttock, thigh, and/or leg pain (sciatica) 
• Neurogenic claudication (leg pain while walking or standing for variable periods of time)
• Pain while bending backward (extension)

Less commonly, muscle spasm, tightness and a burning sensation, or sense of weakness may be felt in the lower back and/or thigh. 6 Matz PG, Meagher RJ, Lamer T, et al. North American Spine Society. Clinical Guidelines for Multidisciplinary Spine Care. Diagnosis and Treatment of Degenerative Lumbar Spondylolisthesis. 2nd ed; 2016.

The Grades of Degenerative Spondylolisthesis

A grading system, also called Meyerding’s classification, is used to measure the degree of slippage in spondylolisthesis. The grading relates to the amount the upper vertebral body slips forward on the lower vertebral body.

The amount of vertebral slip is measured via a side-view x-ray and then graded on a scale of 1 to 4. 7 Tenny S, Gillis CC. Spondylolisthesis. [Updated 2023 May 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430767/ In addition, flexion and extension x-rays (x-rays taken in the neutral, forward- and backward-bent positions) are performed to determine if there is any motion of one vertebra upon the other called translation or rotation.

In most cases, the degree of slippage is low and rarely exceeds grade 2. 1 Akkawi I, Zmerly H. Degenerative Spondylolisthesis: A Narrative Review. Acta Biomed. 2022 Jan 19;92(6):e2021313. doi: 10.23750/abm.v92i6.10526. PMID: 35075090; PMCID: PMC8823594. , 4 Wang YXJ, Káplár Z, Deng M, Leung JCS. Lumbar degenerative spondylolisthesis epidemiology: A systematic review with a focus on gender-specific and age-specific prevalence. J Orthop Translat. 2016;11:39-52. Published 2016 Dec 1. doi:10.1016/j.jot.2016.11.001

The Course of Degenerative Spondylolisthesis

The degree of degenerative spondylolisthesis may increase over time.

The body naturally employs several mechanisms to protect against further slippage, including:

• Formation of bone spurs (a normal response to changes in the amount of stress placed on bone) 
• Hardening of bone (sclerosis)
• Deposition of calcium in the ligaments (ossification)

Because these mechanisms are relatively effective, the degree of degenerative spondylolisthesis is typically small. 4 Wang YXJ, Káplár Z, Deng M, Leung JCS. Lumbar degenerative spondylolisthesis epidemiology: A systematic review with a focus on gender-specific and age-specific prevalence. J Orthop Translat. 2016;11:39-52. Published 2016 Dec 1. doi:10.1016/j.jot.2016.11.001

For most people, degenerative spondylolisthesis is generally asymptomatic or causes mild symptoms that can be managed with nonsurgical treatments. 2 Cushnie D, Johnstone R, Urquhart JC, Gurr KR, Bailey SI, Bailey CS. Quality of Life and Slip Progression in Degenerative Spondylolisthesis Treated Nonoperatively. Spine (Phila Pa 1976). 2018;43(10):E574-E579. doi:10.1097/BRS.0000000000002429

How long degenerative spondylolisthesis takes to heal

The most common case is a low-grade spondylolisthesis without neurological symptoms (symptoms that radiate to the leg, or sciatica), and these typically get better within 1 year of using targeted nonsurgical treatment. 8 Samuel AM, Moore HG, Cunningham ME. Treatment for Degenerative Lumbar Spondylolisthesis: Current Concepts and New Evidence. Curr Rev Musculoskelet Med. 2017 Dec;10(4):521-529. doi: 10.1007/s12178-017-9442-3. PMID: 28994028; PMCID: PMC5685964.

Higher grades of vertebral slippage are rare and may sometimes need surgical treatment.

What makes degenerative spondylolisthesis worse

Occupations or activities that require repetitive forward bending (such as a nanny, a parent who carries small children, or someone who is involved in manual labor) may accelerate the progression of the slip over time. 6 Matz PG, Meagher RJ, Lamer T, et al. North American Spine Society. Clinical Guidelines for Multidisciplinary Spine Care. Diagnosis and Treatment of Degenerative Lumbar Spondylolisthesis. 2nd ed; 2016.

Who may need surgery for degenerative spondylolisthesis

Surgery for degenerative spondylolisthesis is rare. In general, patients with neurological symptoms, such as sensory changes or muscle weakness, who find little or no relief from nonsurgical treatments are more likely to benefit from surgery. 6 Matz PG, Meagher RJ, Lamer T, et al. North American Spine Society. Clinical Guidelines for Multidisciplinary Spine Care. Diagnosis and Treatment of Degenerative Lumbar Spondylolisthesis. 2nd ed; 2016.

Research indicates that 10% to 15% of individuals seeking treatment for degenerative spondylolisthesis eventually opt for surgical treatment. 4 Wang YXJ, Káplár Z, Deng M, Leung JCS. Lumbar degenerative spondylolisthesis epidemiology: A systematic review with a focus on gender-specific and age-specific prevalence. J Orthop Translat. 2016;11:39-52. Published 2016 Dec 1. doi:10.1016/j.jot.2016.11.001

Degenerative Spondylolisthesis vs Isthmic Spondylolisthesis

Isthmic and degenerative spondylolisthesis are distinct conditions with similar symptoms.

It is important to note that a similar type of vertebral slip can also occur due to a structural defect in the small piece of bone, the pars interarticularis, which connects the two vertebrae on the back of the spine. This condition is called isthmic spondylolisthesis .

See Isthmic Spondylolisthesis Symptoms

Spondylolisthesis may also occur due to congenital, traumatic, or pathologic (related to bone disease) causes, but isthmic and degenerative causes are more common. 9 Jhaveri MD, Salzman KL, Ross JS, Moore KR, Osborn AG, Chang Yueh Ho. ExpertDDx : Brain and Spine. Philadelphia Elsevier; 2018.

While the symptoms of both these conditions may overlap, the underlying causes and risk factors are distinct. 

When Degenerative Spondylolisthesis Is Serious

Degenerative spondylolisthesis is typically not a serious condition. The condition can become a medical emergency or require urgent care if it progresses to an extent that crucial spinal nerves are involved, or the stability of the affected segment is compromised. 

In such cases, it is important to be able to identify the warning signs and symptoms of degenerative spondylolisthesis to ensure prompt medical attention and appropriate treatment. 

Serious symptoms and signs are described below. 

Progressive pain and weakness

It is important to seek immediate medical attention if there is persistent or worsening pain in the lower back that interferes with daily activities. The pain may radiate into the buttocks, thighs, or legs and may be accompanied by numbness, tingling, or muscle weakness. Additionally, any concerning progression of neurological symptoms, such as muscle weakness or loss of sensation should be evaluated by a physician urgently. 

Changes in bowel or bladder function

Any changes in bowel or bladder function, such as difficulty controlling or emptying the bladder, bowel incontinence, or numbness in the genital area, is a medical emergency. These symptoms may indicate severe progression of spondylolisthesis leading to a serious condition known as cauda equina syndrome , which requires urgent surgical intervention. 4 Wang YXJ, Káplár Z, Deng M, Leung JCS. Lumbar degenerative spondylolisthesis epidemiology: A systematic review with a focus on gender-specific and age-specific prevalence. J Orthop Translat. 2016;11:39-52. Published 2016 Dec 1. doi:10.1016/j.jot.2016.11.001 , 7 Tenny S, Gillis CC. Spondylolisthesis. [Updated 2023 May 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430767/

See Cauda Equina Syndrome Symptoms

Significant loss of function or mobility

Functional disabilities, such as difficulty walking, maintaining balance, or performing basic movements, may indicate a more advanced stage of the condition that requires prompt medical intervention.

Any of these issues are potentially serious and warrant immediate medical attention.

See When Back Pain May Be a Medical Emergency

A specialist with advanced training in spine care can help evaluate and diagnose degenerative spondylolisthesis. Receiving personalized treatment at an early stage of the condition can help manage pain, prevent further complications, and enhance the overall quality of life for individuals with degenerative spondylolisthesis.

• 1 Akkawi I, Zmerly H. Degenerative Spondylolisthesis: A Narrative Review. Acta Biomed. 2022 Jan 19;92(6):e2021313. doi: 10.23750/abm.v92i6.10526. PMID: 35075090; PMCID: PMC8823594.
• 2 Cushnie D, Johnstone R, Urquhart JC, Gurr KR, Bailey SI, Bailey CS. Quality of Life and Slip Progression in Degenerative Spondylolisthesis Treated Nonoperatively. Spine (Phila Pa 1976). 2018;43(10):E574-E579. doi:10.1097/BRS.0000000000002429
• 3 García-Ramos CL, Valenzuela-González J, Baeza-Álvarez VB, Rosales-Olivarez LM, Alpizar-Aguirre A, Reyes-Sánchez A. Degenerative spondylolisthesis I: general principles. Acta Ortop Mex. 2020;34(5):324-328. doi:10.35366/97997
• 4 Wang YXJ, Káplár Z, Deng M, Leung JCS. Lumbar degenerative spondylolisthesis epidemiology: A systematic review with a focus on gender-specific and age-specific prevalence. J Orthop Translat. 2016;11:39-52. Published 2016 Dec 1. doi:10.1016/j.jot.2016.11.001
• 5 Bernard F, Mazerand E, Gallet C, Troude L, Fuentes S. History of degenerative spondylolisthesis: From anatomical description to surgical management. Neurochirurgie. 2019;65(2-3):75-82. doi:10.1016/j.neuchi.2019.03.006
• 6 Matz PG, Meagher RJ, Lamer T, et al. North American Spine Society. Clinical Guidelines for Multidisciplinary Spine Care. Diagnosis and Treatment of Degenerative Lumbar Spondylolisthesis. 2nd ed; 2016.
• 7 Tenny S, Gillis CC. Spondylolisthesis. [Updated 2023 May 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430767/
• 8 Samuel AM, Moore HG, Cunningham ME. Treatment for Degenerative Lumbar Spondylolisthesis: Current Concepts and New Evidence. Curr Rev Musculoskelet Med. 2017 Dec;10(4):521-529. doi: 10.1007/s12178-017-9442-3. PMID: 28994028; PMCID: PMC5685964.
• 9 Jhaveri MD, Salzman KL, Ross JS, Moore KR, Osborn AG, Chang Yueh Ho. ExpertDDx : Brain and Spine. Philadelphia Elsevier; 2018.

Dr. Marco Funiciello is a physiatrist with Princeton Spine and Joint Center. He has a decade of clinical experience caring for spine and muscle conditions with non-surgical treatments.

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Cervical spondylosis

Cervical spondylosis is a common condition that can cause neck and shoulder pain, often in people over 40. A GP should check more serious cases affecting the spine.

Check if it's cervical spondylosis

Symptoms of cervical spondylosis include:

• neck and shoulder pain or stiffness that can come and go
• headaches that often start at the back of the neck

Cervical spondylosis is a normal part of ageing and many people do not have any symptoms.

How to ease cervical spondylosis symptoms

There are things you can do to help ease neck pain caused by cervical spondylosis.

Do try gentle neck exercises improve your posture take painkillers, like paracetamol and ibuprofen , to ease any pain and stiffness A pharmacist can help with cervical spondylosis

A pharmacist may be able to recommend stronger painkillers if you need them.

Neck exercises

Chartered Society of Physiotherapy: neck pain exercises

Urgent advice: Ask for an urgent GP appointment or get help from NHS 111 if you have:

• pain that's getting much worse
• heaviness or weakness in your arms or legs
• pins and needles in an arm, as well as pain in your neck or arm
• neck pain that is worse when you move
• pain between your shoulder blades
• a stiff neck
• poor balance

You can call 111 or get help from 111 online

Immediate action required: Call 999 if you have any of these:

• new problems walking
• loss of bladder or bowel control
• sudden lack of co-ordination – for example, with tasks like buttoning a shirt
• somebody's face droops on 1 side (the mouth or eye may have drooped)
• a person cannot lift up both arms and keep them there
• a person has difficulty speaking (speech may be slurred or garbled)

These can be signs of a medical emergency.

What happens at your GP appointment

The GP will examine your neck and shoulder if they think you may have cervical spondylosis.

They may also test your reflexes and watch you walk.

Depending on your symptoms you may be sent for other tests such as X-rays or scans.

Treatment for cervical spondylosis

Treatment for cervical spondylosis depends on how bad your symptoms are.

The GP may give you more exercises to do and recommend you carry out your usual activities as much as possible.

The GP may also prescribe a muscle relaxant or other medicine if the pain has been coming and going for a long time (chronic pain).

It usually takes a few weeks for treatment to work, although the pain and stiffness can come back.

Surgery is only considered if:

• a nerve is being pinched by a slipped disc or bone (cervical radiculopathy)
• there's a problem with your spinal cord (cervical myelopathy)

Surgery is not always a cure but it may stop your symptoms getting worse.

Physiotherapy for cervical spondylosis

If your symptoms do not improve in a few weeks the GP may recommend physiotherapy.

Waiting times for physiotherapy on the NHS can be long.

You can also get physiotherapy privately.

Find a registered physiotherapist on the Chartered Society of Physiotherapy website

Self-refer for treatment

If you have cervical spondylosis, you might be able to refer yourself directly to services for help with your condition without seeing a GP.

To find out if there are any services in your area:

• ask the reception staff at your GP surgery
• check your GP surgery's website
• contact your integrated care board (ICB) – find your local ICB
• search online for NHS treatment for cervical spondylosis near you

Causes of cervical spondylosis

Many people over 40 get cervical spondylosis as part of getting older.

It happens when ageing causes wear and tear to bones in the spine and the soft cushions of tissue (discs) in the neck.

You may also be more likely to get cervical spondylosis at any age if:

• you have previously had a neck injury
• you have a family history of the condition

Page last reviewed: 02 August 2023 Next review due: 02 August 2026

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Spondylosis vs Spondylolysis vs Spondylolisthesis: What’s the Difference?

As we age, our bodies undergo various changes, and the spine is no exception. Conditions like spondylosis , spondylolysis , and spondylolisthesis are commonly heard medical terms related to the spine. While they sound similar, they each have specific characteristics and modes of treatment. Knowing what they mean is just the first step to finding healing – it’s important to get a correct diagnosis from the start so you can work with a spinal expert to create a customized treatment plan for your condition. 

What is Spondylosis?

Spondylosis , also known as spinal osteoarthritis , is a degenerative condition that affects the spine. 

Causes & Risk Factors of Spondylosis

Spondylosis is typically associated with age and results from the wear and tear of the spinal discs and facet joints over time. As we grow older, the discs between our vertebrae begin to lose water content, making them less flexible. This leads to the formation of bone spurs (osteophytes) along the edges of the vertebrae, which can cause pain and reduced mobility.

Symptoms of Spondylosis

Patients with Spondylosis often experience stiffness, localized pain, and reduced range of motion. 

If left untreated, patients with Spondylosis can experience:

• Pain and Discomfort
• Limited Mobility
• Nerve Compression
• Muscle Weakness and Atrophy
• Spinal Instability
• Reduced Quality of Life
• Functional Impairment
• Neurological Complications

Treatments for Spondylosis

Treatment approaches can include physical therapy, pain management techniques, lifestyle modifications, and in some cases, surgical interventions. If patients fail initial non-operative approaches, your spinal specialist at the Virginia Spine Institute will discuss the many different approaches for surgical intervention. The goal of surgical intervention is to stabilize the spine, alleviate pressure from the nerves, and correct any structural deformity. Every surgical plan is personalized to our patients depending on his or her symptoms or spinal needs.

What is Spondylolysis?

Spondylolysis is a stress fracture or weakness in the pars interarticularis bone found in the lower part of the spine. The pars interarticularis is the weakest part of the spine, especially in younger patients whose bones are still maturing. 

Causes & Risk Factors of Spondylolysis

Spondylolysis is often caused by overuse of the lower back – usually as a result of repetitive or traumatic impact from repetitive hyperextension of the spine from a sport like gymnastics, football, or weightlifting. It is also commonly seen in those who have experienced a car accident, a fall, or degenerative/genetic changes to the bone.

Symptoms of Spondylolysis

Symptoms of Spondylolysis may include back pain, muscle spasms, stiffness in the lower back (especially during physical activities), and muscle tightness.

Symptoms can range from mild to severe depending on the severity of the fracture or instability in the spine. In some cases, you may have symptoms of radiculopathy . These include pain, numbness, weakness, or tingling in the legs. If the fracture is severe enough causing a slippage, referred to as isthmic spondylolisthesis , there may be varying degrees of central stenosis which can be severely pinching the nerves. If you experience loss of bowel or bladder control, urinary urgency, numbness or weakness in the legs, or numbness in the groin, contact your spinal expert immediately

What Happens if Spondylolysis is Left Untreated?

If left untreated, Spondylolysis can potentially lead to various complications and health issues, including – Chronic pain, Degenerative disc disease, or even progress to Spondylolisthesis, which may result in further instability and nerve compression.

Treatments for Spondylolysis

Treatment is often aimed first toward symptom management by way of non-surgical treatment – such as spine-specialized physical therapy , manual massage, anti-inflammatory medications , dry needling, low-impact exercise, and proper nutrition.  We have also found great success in using regenerative medicine treatment options to treat these types of pars fractures.

In severe cases or if conservative methods fail, your spine specialist may recommend surgical options. The goal of surgery is to stabilize the spinal segment, most commonly through a spinal fusion procedure. This decreases the amount of motion of one vertebral segment on top of another to reduce pain, relieve pressure off of nerves, increase stability, and correct misalignment. Each surgical plan is determined after a thorough evaluation with your spinal specialist at the VSI and is specific to each patient.

What is Spondylolisthesis?

Spondylolisthesis is a medical diagnosis to describe the forward slippage of one vertebral body in relation to the vertebra below. It is closely related to spondylolysis and often occurs as a consequence of it. 

When the pars interarticularis weakens or fractures in spondylolysis, it can cause the affected vertebra to slip forward over another, resulting in spondylolisthesis.

Causes & Risk Factors of Spondylolisthesis

The spine is made of several motion segments stacked on top of one another to allow for smooth movement in all directions. Each of these segments has three major points of contact including two facet joints and an intervertebral disc. If the facet joint and intervertebral discs degenerate or experience trauma this could lead to abnormal motion and misalignment. 

Another common cause of spondylolisthesis is a stress fracture in the vertebra. This is often diagnosed and treated by the specialists at the Virginia Spine Institute.

Symptoms of Spondylolisthesis

Symptoms may include pain, discomfort, stiffness, and muscle spasms in the lower back. Symptoms of radiculopathy may also appear. If the slippage is severe and causes detrimental pressure on the spinal nerves, you may develop symptoms of cauda equina syndrome. These include numbness in the groin area or down the legs, loss of bowel or bladder control, urinary urgency, or difficulty with balance or walking. Cauda equina is a spinal emergency and if you are experiencing these symptoms seek immediate evaluation.

If left untreated, Spondylolisthesis symptoms can lead to:

• Further degenerative changes
• Chronic pain and discomfort
• Nerve compression
• Loss of function 
• Progressive deformity
• In rare or severe cases, bowel and bladder dysfunction. This can further lead to complications with daily activities and reduced quality of life.

Treatments for Spondylolisthesis

Treatment varies based on the severity of the symptoms and degree of slippage. 

Conservative, non-operative treatment options which may include spine-specialized physical therapy , core strengthening, manual massage, dry needling, low-impact exercise, and maintaining an overall healthy lifestyle.

If patients fail non-operative treatment or are developing worsening neurologic symptoms surgery is often discussed. The goal of surgical intervention is to stabilize the spine, alleviate pressure from the nerves, and correct any structural deformity. There are many different approaches for surgical intervention which your spinal specialist at the Virginia Spine Institute will discuss with you in detail. 

When Should You See a Spine Specialist for Spondylosis, Spondylolysis, or Spondylolisthesis?

Spondylosis, spondylolysis, and spondylolisthesis are distinct conditions affecting the spine, each with its unique causes and characteristics.  While each of these conditions is different, they present and can be treated in similar ways. 

Getting a thorough evaluation and correct diagnosis at your first appointment allows for early intervention, and is essential in managing these conditions effectively and improving your overall quality of life. If you experience persistent back pain or suspect any spinal issues, schedule a consultation with one of our VSI spine specialists. They will discuss both conservative and surgical treatment options during your initial consultation; all personalized to your specific symptoms and spinal needs.

Topics covered

About the author.

Dr. William Kemp is a fellowship-trained spine neurosurgeon skilled in treating spinal conditions ranging from common back and neck conditions to scoliosis reconstruction and complex removal of spinal cysts. With 16 years of education and training at world-class academic medical centers, he completed his neurosurgery residency at Cleveland Clinic.

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