Spondylolisthesis

What is spondylolisthesis?

Spondylolisthesis happens when one of the vertebrae in your spine slips out of position and puts pressure on the vertebra below it. Spondylolisthesis is pronounced spohn-di-low-less-THEE-sis.

Your spine is made of 33 stacked bones called vertebrae (the plural form of vertebra). Your vertebrae are linked together but can move a little bit as you move your body and change your posture.

If you have spondylolisthesis, one of your vertebrae moves more than it should and slides out of its usual spot and onto the vertebra below it. This can put pressure on nerves around your spine and cause back pain and other symptoms.

Spondylolisthesis can happen anywhere in your spine, but it’s most common in your lower back (lumbar spine). It can also affect your neck (cervical spine) or your midback from the bottom of your neck to just below your ribs (thoracic spine).

The vertebrae in your spine are links in a chain that constantly support you. It might sound scary to think about one of those links falling out of alignment, but that doesn’t mean the whole chain is in trouble. Spondylolisthesis usually responds very well to treatment. Visit a healthcare provider if you notice new pain in your back, legs or anywhere else that’s making it hard to move throughout your day.

Spondylolisthesis types

There are several spondylolisthesis types, including:

• Degenerative spondylolisthesis: This is the most common type. It happens as your body naturally ages and the disks that cushion the spaces between your vertebrae break down (degenerate). As the disks thin, there’s more space between your vertebrae, which increases the risk one slips out of place. Degenerative spondylolisthesis is a type of degenerative disk disease.
• Congenital spondylolisthesis (dysplastic spondylolisthesis): Congenital spondylolisthesis happens when a baby’s spine doesn’t form the way it should before they’re born. The misaligned vertebrae can cause issues right away or much later in life.
• Isthmic spondylolisthesis: This happens when the bone that connects two vertebrae together (the pars interarticularis) breaks and can’t hold its usual alignment. That fractured vertebra then slips out of place.

Less common spondylolisthesis types include:

• Traumatic spondylolisthesis: Any injury or accident that puts enough force on your spine can push a vertebra out of place.
• Pathological spondylolisthesis: Conditions that weaken your bones (like osteoporosis or a tumor) can cause spondylolisthesis.
• Postsurgical spondylolisthesis: It’s rare, but spondylolisthesis can be a side effect of having spinal surgery.

What are spondylolisthesis symptoms?

Some people have spondylolisthesis and never experience symptoms. Very minor (low-grade) slippage may not put enough pressure on the rest of your spine or nerves to cause any symptoms.

If you do have symptoms, they might include:

• Lower back pain.
• Sciatica (pain in your legs).
• Back stiffness.
• Difficulty walking or standing for more than a few minutes at a time.
• Numbness, weakness or tingling in your feet.

You might feel pain in other areas of your back, depending on where in your spine the vertebra slips out of place. The pain might spread (radiate) into your butt (buttocks) or thighs.

What causes spondylolisthesis?

What makes a vertebra slip out of alignment depends on which type of spondylolisthesis you have. The most common causes include:

• Natural aging and wear and tear on your spinal disks.
• Having naturally thinner vertebrae than usual.
• Sports injuries.
• Growth spurts (in kids and teens).
• Traumas like falls or car accidents.

What are the risk factors?

Spondylolisthesis can affect anyone, but some people have a higher risk, including:

• People older than 50.
• People assigned female at birth (AFAB).
• Athletes (especially people who play contact sports or have to jump or stretch a lot).
• People with a biological family history of spondylolisthesis or conditions that affect their bone health.

What are the complications of spondylolisthesis?

If it’s not diagnosed and treated, spondylolisthesis can increase your risk of:

• Chronic pain in your back.
• Spinal arthritis.
• Nerve damage.
• Trouble controlling when you pee (urinary incontinence) or poop (bowel incontinence).

How do healthcare providers diagnose spondylolisthesis?

A healthcare provider will diagnose spondylolisthesis with a physical exam and imaging tests. They’ll examine your back and spine.

Tell your provider when you first noticed pain or other symptoms, and if any activities or movements make the symptoms worse. Let your provider know what you were doing before symptoms started, especially if you know you experienced a specific injury.

Your provider will use a spinal X-ray to take pictures of your vertebrae. You might also need a CT scan (computed tomography scan) or MRI (magnetic resonance imaging) to look for damage to your disks or nerves.

Spondylolisthesis grades

Your provider will classify the spondylolisthesis with a grade to indicate how far out of position your vertebra slipped. They might use a number grade or simply define it as low or high:

• Low-grade spondylolisthesis (Grade I and Grade II): Low-grade spondylolisthesis is the most common type. Most teens with isthmic spondylolisthesis and adults with degenerative spondylolisthesis have low-grade cases.
• High-grade spondylolisthesis (Grade III and Grade IV): High-grade cases are much more likely to require surgery, especially if you’re experiencing severe pain or other symptoms.

What are spondylolisthesis treatments?

Most people with spondylolisthesis can manage their symptoms with nonsurgical treatments, including:

• Rest: Taking a break from sports and other intense physical activities reduces stress on your spine.
• Medications: Over-the-counter (OTC) NSAIDs or acetaminophen can help reduce pain and inflammation. Don’t take over-the-counter pain relievers for more than 10 days in a row without talking to your provider. Talk to your provider before starting any at-home medications — they’ll tell you which ones are safe for you.
• Corticosteroids: Corticosteroids are prescription anti-inflammatory medications. Your provider might prescribe you an oral medication that you’ll take by mouth. They might also give you a cortisone shot directly into the affected area.
• Physical therapy: A physical therapist will give you exercises to strengthen the muscles around your spine, including your back muscles and your core (your abdominal muscles). This can relieve stress on your spine and help you move better.
• Wearing a brace: If you have a vertebra fracture, your provider might recommend you wear a back brace to stabilize your spine. Your provider will tell you how long you’ll need to wear a brace.

When do you need surgery for spondylolisthesis?

Not everyone needs surgery to fix spondylolisthesis. It’s possible to live with a low-grade slippage if the out-of-place vertebra doesn’t cause severe symptoms or increase your risk of complications.

Your provider will tell you when it might be time to consider surgery. You’re more likely to need surgery if you:

• Have high-grade spondylolisthesis.
• Experience severe pain or other symptoms that affect your ability to stand, walk or move.
• Have tried other, nonsurgical treatments and still have symptoms.

Your surgeon will probably do a spinal fusion to realign your vertebrae and give the area around them more strength. You might also need a spinal decompression to remove extra pressure on your sciatic nerve.

Your provider or surgeon will tell you which type of surgery you’ll need and what to expect.

Spondylolisthesis surgery side effects

Some people who need a spinal fusion have a reduced range of motion or flexibility in their back after surgery. Spinal fusion joins two vertebrae that heal into one bone. For most people, that tradeoff is worth it because they experience much less pain. But don’t be afraid to talk to your surgeon before you decide to have surgery. They’ll help you understand the risks and set realistic goals.

Can I prevent spondylolisthesis?

You might not always be able to prevent spondylolisthesis, especially because sudden injuries or the way your spine forms can cause it. You can lower your risk with these tips:

• Do physical activities that strengthen your back and abdominal muscles.
• Follow an eating plan that’s healthy for you. This can help protect your bones and overall health.
• Talk to your provider about your bone health. They’ll tell you when you’ll need regular bone density tests.

What can I expect if I have spondylolisthesis?

If you have spondylolisthesis, nonsurgical treatments like rest, medication and physical therapy should improve your symptoms. Your provider will take additional X-rays as you start treatment to see if your vertebra moves further out of alignment. Your provider will keep an eye on the out-of-place vertebra. If it moves too much, you might need surgery.

Nonsurgical treatments can’t realign the out-of-place vertebra, but they can help you return to your daily activities without pain. Only surgery can restore your spine’s original alignment.

It can take anywhere from a few weeks to a few months to recover completely after spine surgery. Your surgeon will give you a customized recovery timeline based on your specific needs.

When can I resume playing sports?

Most people with spondylolisthesis can resume sports and other physical activities after a few weeks of treatment. You’ll usually need to wait until you can safely move without pain.

Talk to your provider or surgeon before resuming any physical activities. They’ll suggest safe ways for you to stay active without increasing your risk of complications.

What can you not do with spondylolisthesis?

Your provider will tell you which kinds of activities are safe for you to do. You might have to avoid contact sports or intense physical activities that stretch or put a lot of stress on your spine.

When should I see my healthcare provider?

The sooner you see a healthcare provider, the faster they can diagnose and treat spondylolisthesis. Visit a provider as soon as you notice back pain that lasts more than a few days or if you have pain that’s severe enough to stop you from doing your usual activities.

When should I go to the emergency room?

Go to the emergency room if you experience a trauma like a fall or car accident. Go to the ER if you lose feeling in your legs or can’t control your bladder or bowels.

Which questions should I ask my doctor?

You may want to ask your provider:

• Do I have spondylolisthesis or another type of back issue?
• Which treatments will I need?
• Will I need surgery?
• When can I return to physical activities like playing sports?

What is the difference between spondylolisthesis and spondylolysis?

Spondylolisthesis and spondylolysis are similar conditions with confusingly similar names. The difference between them is how they affect your spine.

Spondylolisthesis happens when a vertebra slips out of place in your spine and presses on the vertebra below it.

Spondylolysis is a crack (a tiny bone fracture) between two vertebrae. Specifically, it’s a fracture in the pars interarticularis — the small ridges of bone that link your vertebrae together. Spondylolysis is one of the most common causes of isthmic spondylolisthesis. The crack between two vertebrae can make one slip out of alignment.

A note from Cleveland Clinic

It’s always scary to hear that something is affecting your spine. Your mind might start racing when you hear that a bone is out of place in such an important part of your body. It’s completely natural to feel surprised or have lots of questions.

Take a second to catch your breath. Spondylolisthesis is hard to spell and pronounce, but (fortunately) not all conditions with complicated names require super-complex treatments. You might only need a few weeks of rest, OTC medications and some physical therapy. Even if you do end up needing surgery, you should be back to all your usual activities after your body has time to heal.