Spondylolisthesis is a condition in which one of the spinal vertebrae shifts or slips out of place. The displaced vertebra may rest directly on top of another vertebra, and this can cause lower back pain, nerve injury, and further deterioration. Treatment can improve quality of life, alleviate symptoms, and reduce the risk of long-term spinal degeneration.
Spondylolisthesis may or may not cause symptoms. Those who do experience symptoms may experience the following:
- Pain in the lower back
- Stiffness in the lower back
- Muscle spasms or tightness in the hamstrings (back of the thighs)
- Pain when bending over
- Pain that radiates down into the buttocks and thighs
- Numbness, weakness, or tingling down into the foot
- Pain that worsens with activity and improves with rest
- Difficulty walking or standing for long periods of time
Treatment for spondylolisthesis usually begins with a conservative approach. Depending on the effectiveness of conservative treatments, the severity of symptoms, and the patient’s unique needs, surgery may be advised.
- Rest: Temporarily avoiding athletic activities and other activities that place excessive stress on the lower back can help relieve symptoms.
- Physical Therapy (PT): PT is often recommended to improve flexibility, strengthen the muscles, and stretch tight muscles affected by spondylolisthesis.
- Anti-Inflammatory Medication: Non-steroidal anti-inflammatory medications can decrease inflammation, swelling, and pain from spondylolisthesis.
- Injections: Some patients may benefit from spinal injections (such as steroids) to relieve symptoms.
- Back Bracing: A back brace may be worn to temporarily limit movement in the spine and allow a recent fracture the chance to heal. Candidates for bracing are usually young athletes and those with acute onset of pain, not those with chronic symptoms.
- Minimally Invasive Spinal Fusion: Minimally invasive spinal fusion surgery can stabilize the spine by permanently fusing together two or more spinal vertebrae. This restricts some mobility of the spine but can alleviate symptoms and prevent further slippage.
- Spinal Decompression: Minimally invasive microscopic decompression of the lumbar spine may be necessary to prevent ongoing nerve damage from spondylolisthesis.
Frequently Asked Questions
A diagnosis of spondylolisthesis can be confirmed with an evaluation of symptoms, a physical examination, detailed medical history, and diagnostic testing (such as X-ray, CT scan, and/or MRI scan).
The three most common causes of spondylolisthesis include:
- Congenital spondylolisthesis: A vertebrae is defective from birth.
- Isthmic spondylolisthesis: A stress fracture or small crack in a vertebra causes it to slip.
- Degenerative spondylolisthesis: Age-related degeneration of the spinal discs causes them to thin, resulting in the slippage of a vertebra.
Less common causes of spondylolisthesis include:
- Traumatic spondylolisthesis: An injury causes a vertebra to slip.
- Pathological spondylolisthesis: Another condition (such as osteoporosis or cancer) causes a vertebra to slip.
- Post-surgical spondylolisthesis: After a spinal surgery, a vertebra slips out of place.
Risk factors for spondylolisthesis include:
- Being an athlete (especially a young athlete)
- Genetics (having thinner areas of vertebrae)
- Aging (especially over age 50)
- Having a degenerative spinal condition
The most common risk of not treating spondylolisthesis is that symptoms can become chronic (and may worsen over time). Another significant concern is the long-term risk to spinal health. Spondylolisthesis may place pressure on the nerves or spinal cord, which can eventually lead to permanent damage and even paralysis. If you believe you or your child may have spondylolisthesis, it is important to get evaluated by an orthopedic surgeon to determine how best to manage the symptoms and safeguard long-term health.
Most patients will be advised to try conservative treatment methods before considering surgery. If the slippage is progressively worsening, if it is high-grade slippage (more than half the width of the vertebra has slipped forward), if symptoms are severe, and/or if symptoms have not improved with nonsurgical treatment, then surgery may be recommended. In most cases where spondylolisthesis surgery is recommended, surgical techniques will include spinal decompression with or without fusion.
With treatment, most patients with spondylolisthesis will be able to resume normal activities free of symptoms and with few complications in a few weeks or months. Those with more severe spondylolisthesis (and especially those who need surgery) have a greater risk of recurrence, and they may be advised to perform various exercises and get regular check-ups to monitor their spinal health.