Spondylolisthesis

Overview

What is spondylolisthesis?

Spondylolisthesis is a condition involving spine instability, which means the vertebrae move more than they should. A vertebra slips out of place onto the vertebra below. It may put pressure on a nerve, which could cause lower back pain or leg pain.

The word spondylolisthesis (pronounced spohn-di-low-less-THEE-sis) comes from the Greek words spondylos, which means "spine" or "vertebra," and listhesis, which means "slipping, sliding or movement."

Is spondylolisthesis the same as spondylolysis?

Both spondylolysis and spondylolisthesis cause low back pain. They are related but not the same.

  • Spondylolysis: This spine defect is a stress fractures or crack in spine bones. It’s common in young athletes.
  • Spondylolisthesis: This condition is when a vertebra slips out of place, resting on the bone below it. Spondylolysis may cause spondylolisthesis when a stress fracture causes the slipping. Or the vertebra may slip out of place due to a degenerative condition. The disks between vertebrae and the facet joints (the two back parts of each vertebrae that link the vertebrae together) can wear down. Bone of the facet joints actually grows back and overgrows, causing an uneven and unstable surface area, which makes the vertebrae less able to stay in place. No matter what the cause, when the vertebra slips out of place, it puts pressure on the bone below it. Most cases of spondylolisthesis do not cause symptoms. If you feel leg pain, it can also be caused by compression or a "pinching" of the nerve roots that exit the spinal canal (the tunnel created by the interlocking vertebrae of the spine). The compression or pinching is due to the vertebrae slipping out of position and narrowing the needed space for the nerves.

What are the types of spondylolisthesis?

Types of spondylolisthesis include:

  • Congenital spondylolisthesis occurs when a baby’s spine doesn’t form the way it should before birth. The misaligned vertebrae put the person at risk for slippage later in life.
  • Isthmic spondylolisthesis happens as a result of spondylolysis. The crack or fracture weakens the bone.
  • Degenerative spondylolisthesis, the most common type, happens due to aging. Over time, the disks that cushion the vertebrae lose water. As the disks thin, they are more likely to slip out of place.

Less common types of spondylolisthesis include:

  • Traumatic spondylolisthesis happens when an injury causes vertebrae to slip.
  • Pathological spondylolisthesis occurs when a disease — such as osteoporosis — or tumor causes the condition.
  • Post-surgical spondylolisthesis is slippage as a result of spinal surgery.

How common is spondylolisthesis?

Spondylolisthesis and spondylolysis occur in about 4% to 6% of the adult population. It’s possible to live with spondylolisthesis for years and not know it, since you may not have symptoms.

Degenerative spondylolisthesis (which occurs due to aging and wear and tear on the spine), is more common after age 50 and more common in women than men.

When back pain occurs in teens, isthmic spondylolisthesis (usually caused by spondylolysis) is one of the most common causes.

Who is at risk for spondylolisthesis?

You may be more likely to develop spondylolisthesis due to:

  • Athletics: Young athletes (children and teens) who participate in sports that stretch the lumbar spine, such as gymnastics and football, are more likely to develop spondylolisthesis. The vertebra slippage tends to occur during children’s growth spurts. Spondylolisthesis is one of the most common reasons for back pain in teens.
  • Genetics: Some people with isthmic spondylolisthesis are born with thinner section of the vertebra called the pars interarticularis. This thin piece of bone connects the facet joints, which link the vertebrae directly above and below to form a working unit that permits movement of the spine. These thinner areas of vertebrae are more likely to fracture and slip. Degenerative spondylolisthesis also has a large genetic component.
  • Age: As we age, degenerative spine conditions can develop, which is when wear and tear on the spine weakens the vertebrae. Older adults with degenerative spinal conditions may be at higher risk for spondylolisthesis. It becomes more common after age 50.

What is low-grade versus high-grade spondylolisthesis?

To determine how severe spondylolisthesis is, your healthcare provider gives it a grade:

  • Low-grade (Grade I and Grade II) typically don’t require surgery. Low grade cases are usually seen in adolescents with isthmic spondylolisthesis and in almost all cases of degenerative spondylolisthesis.
  • High-grade (Grade III and Grade IV) may require surgery if you’re in a lot of pain.

Will I need surgery for spondylolisthesis?

Your healthcare provider will start with nonsurgical options, such as rest and physical therapy. These treatments often relieve symptoms. Your healthcare provider may recommend surgery if you:

  • Have high-grade spondylolisthesis.
  • Experience severe pain.
  • Tried nonsurgical treatments but still have symptoms.

Symptoms and Causes

What causes spondylolisthesis?

Overextending the spine is one of the main causes of spondylolisthesis in young athletes. Genetics may play a role, too. Some people are born with thinner vertebral bone. In older adults, wear and tear on the spine and disks (the cushions between vertebrae) can cause this condition.

What are the symptoms of spondylolisthesis?

You may not experience any symptoms of spondylolisthesis. Some people have the condition and don’t even know it. If you do have symptoms, lower back pain is typically the main one. The pain may extend to the buttocks and down the thighs. You may also experience:

  • Muscle spasms in the hamstring (muscles in the back of the thighs).
  • Back stiffness.
  • Difficulty walking or standing for long periods.
  • Pain when bending over.
  • Numbness, weakness or tingling in the foot.

Diagnosis and Tests

How is spondylolisthesis diagnosed?

Your healthcare provider will do a physical exam and ask you about your symptoms. You will then likely need an imaging scan to confirm the diagnosis.

What imaging tests will I need?

  • Spinal X-ray helps healthcare providers see if a vertebra is out of place.
  • CT scan or MRI scan may be necessary to see the spine in more detail or to see soft tissue such as discs and nerves.

Management and Treatment

How do healthcare providers treat spondylolisthesis?

Treatment depends on the grade of the slippage, your symptoms, age and overall health. Your healthcare provider will discuss treatment options with you. You may need medication, physical therapy or surgery.

What nonsurgical treatments are available for spondylolisthesis?

Nonsurgical treatments include:

  • Rest: Take a break from strenuous activities and sports.
  • Medication: An over-the-counter nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen (Motrin®) or naproxen (Aleve®), can bring relief. If those don’t work, your healthcare provider may prescribe other medications.
  • Injections: You receive an injection of steroid medications directly into the affected area.
  • Physical therapy: A physical therapist can teach you targeted exercises to strengthen your abdomen (belly) and back. Daily exercises often relieve pain after a few weeks.
  • Bracing: A brace can help stabilize your spine. The brace limits movement so that fractures can heal. Braces are not used in adults.

How do I know if I need surgery for spondylolisthesis?

You may need surgery if you have high-grade spondylolisthesis, the pain is severe or you’ve tried nonsurgical treatments without success. The goals of spondylolisthesis surgery are to:

  • Relieve pain from the irritated nerve.
  • Stabilize the spine where the vertebra has slipped.
  • Restore your function.

What happens during surgery for spondylolisthesis?

Surgery for back pain due to spondylolisthesis typically involves spinal decompression, with or without fusion. Decompression alone is almost never done in isthmic spondylolisthesis. Studies show fusion with decompression may give better outcome than decompression alone. During a decompression surgery, your surgeon removes bone and disk from the spine. This procedure gives the nerves space inside the spinal canal, relieving pain.

For a fusion surgery, your surgeon fuses (connects) the two affected vertebrae. As they heal, they form into one bone, eliminating movement between the two vertebrae. You may experience some limited spinal flexibility as a result of the surgery.

Will spondylolisthesis come back?

Most of the time, pain is gone after you recover from spondylolisthesis surgery. You can gradually begin to resume your activities until you are back to full function and movement.

Prevention

How can I reduce my risk of spondylolisthesis?

You can take steps to reduce your risk of spondylolisthesis:

  • Do regular exercises for strong back and abdominal muscles.
  • Maintain a healthy weight. Excess weight puts added stress on your lower back.
  • Eat a well-balanced diet to keep your bones well-nourished and strong.

After treatment, how can I prevent spondylolisthesis from returning?

Your healthcare provider may recommend exercises to strengthen the back and abdominal muscles, especially for children. Make sure to have regular checkups so your healthcare provider can detect any problems early on.

The chances of spondylolisthesis coming back, or recurring, are higher if the grade was higher. For people with a minor slippage, the condition may never come back.

Outlook / Prognosis

What is the outlook for people with spondylolisthesis?

Surgery has a high success rate. People who have surgery for spondylolisthesis often return to an active life within a few months of surgery. You will likely need rehabilitation after surgery to help you get back to full function.

Living With

Will spondylolisthesis go away on its own?

While the condition won’t go away on its own, you can often experience relief through rest, medication and physical therapy.

Can spondylolisthesis be reversed?

Nonsurgical treatments cannot undo the crack or slippage, but they can provide long-term pain relief. Surgery can relieve pressure on the nerves, stabilize the vertebrae and restore your spine’s strength.

What can I do about pain from spondylolisthesis?

First, take a break from strenuous activity and exercise. Try over-the-counter medications to relieve pain and inflammation. And make sure to see your healthcare provider, who can help you figure out next steps.

A note from Cleveland Clinic

Spondylolisthesis is a common cause of back pain, but it is not dangerous and doesn’t need to take over your life. Many treatments are available, from medication and physical therapy to spinal surgery. If you have low back pain or find it difficult to walk, stand or bend over, talk to your healthcare provider to find out how you can feel better.

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