unstable spondylolisthesis symptoms

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: 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.

• Degenerative Spondylolisthesis Symptoms

By: Marco Funiciello, DO, Physiatrist

Peer-Reviewed

Degenerative spondylolisthesis typically causes low back pain along with a cluster of symptoms and signs in one or both legs.

Degenerative Spondylolisthesis: Common Symptoms and Signs

Degenerative spondylolisthesis symptoms include neurogenic claudication, sciatica, and radiculopathy.

In degenerative spondylolisthesis, the degenerated facet joints and other parts of the vertebral bone tend to increase in size. The enlarged, abnormal bone then encroaches upon the central canal and/or nerve hole (foramen) causing spinal stenosis or foraminal stenosis.

In This Article:

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

Degenerative Spondylolisthesis Video

These changes typically result in some combination of the following symptoms and signs.

Persistent low back pain

Low back pain caused by degenerative spondylolisthesis is usually persistent and described as a consistent dull ache, 1 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 but it may also feel like a sharp, stabbing sensation for some individuals.

The pain is typically localized in the low back region and may worsen with physical activity, standing, or walking.

Neurogenic claudication

Intermittent neurogenic claudication affects around 75% of people with degenerative spondylolisthesis. It is characterized by episodes of low back pain that radiate to both legs, along with accompanying sensations of tingling, a sensation of weakness, and hamstring spasm. 2 Li N, Scofield J, Mangham P, Cooper J, Sherman W, Kaye A. Spondylolisthesis. Orthop Rev (Pavia). 2022 Jul 27;14(4):36917. doi: 10.52965/001c.36917. PMID: 35910544; PMCID: PMC9329062. , 3 García-Ramos CL, Valenzuela-González J, Baeza-Álvarez VB, Rosales-Olivarez LM, Alpizar-Aguirre A, Reyes-Sánchez A. Degenerative spondylolisthesis I: general principles. Espondilolistesis degenerativa lumbar I: principios generales. Acta Ortop Mex. 2020;34(5):324-328.. , 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

It is possible to have any combination of symptoms and they typically occur during walking variable distances or prolonged standing. 2 Li N, Scofield J, Mangham P, Cooper J, Sherman W, Kaye A. Spondylolisthesis. Orthop Rev (Pavia). 2022 Jul 27;14(4):36917. doi: 10.52965/001c.36917. PMID: 35910544; PMCID: PMC9329062.

Sciatica: Radiating leg pain

Back pain may radiate into the buttock, thighs, and into the leg and foot. 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

Radiating leg pain is commonly known as sciatica . This pain occurs due to the irritation, compression, or inflammation of spinal nerve roots in the lower back. 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

Radiculopathy: Abnormal sensations, weakness, and loss of muscle reflexes

When the spinal nerve roots are compressed or sufficiently inflamed and neurologic deficits are present, the condition is called radiculopathy . Radiculopathy may cause leg weakness and affect muscle reflexes. Additionally, numbness may be felt in the thigh, leg, and/or foot. 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

It may be challenging to perform activities that require strength, such as walking, climbing stairs, or lifting objects.

Little Known Symptoms of Degenerative Spondylolisthesis

As degenerative spondylolisthesis progresses, the symptoms may lessen due to compensatory mechanisms of the spine that increase spinal stability and prevent further progression.

However, in some individuals, the progression may continue and cause the following symptoms and signs.

Sleep disturbances 

Back pain and leg pain may cause disturbed sleep or trouble falling asleep. 5 Kalichman L, Hunter DJ. Diagnosis and conservative management of degenerative lumbar spondylolisthesis. Eur Spine J. 2008;17(3):327-335. doi:10.1007/s00586-007-0543-3

For this reason, some individuals may choose to sleep in the fetal position (sleeping on the side with knees bent close to the chest) to relieve leg symptoms. 5 Kalichman L, Hunter DJ. Diagnosis and conservative management of degenerative lumbar spondylolisthesis. Eur Spine J. 2008;17(3):327-335. doi:10.1007/s00586-007-0543-3

Restless leg syndrome

Leg pain and claudication may sometimes cause restless legs syndrome. In this condition, aching or burning pain in the calves causes an irresistible urge to move the legs continuously, causing disturbed sleep. 5 Kalichman L, Hunter DJ. Diagnosis and conservative management of degenerative lumbar spondylolisthesis. Eur Spine J. 2008;17(3):327-335. doi:10.1007/s00586-007-0543-3

Difficulty walking and imbalance

Degenerative spondylolisthesis may cause difficulty walking and maintaining balance.

As degenerative spondylolisthesis progresses, difficulties with walking and maintaining balance may be experienced. These signs arise from nerve compression caused by the slipped vertebra and associated degenerative changes,  Altered posture, muscle weakness and reduced coordination may result. 6 Studnicka K, Ampat G. Lumbosacral Spondylolisthesis. [Updated 2022 Sep 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560679/

There are many nerves in our legs that are responsible for relaying information to the brain about position and balance. If these nerves are irritated or compressed in the spine then the brain may not get the necessary information needed for good balance and posture control. 

These changes can impact mobility and function, making it harder to engage in normal daily activities.

Limited range of motion

Degenerative spondylolisthesis can affect lumbar range of motion due to the degenerative bone changes that prevent full segmental motion. Muscle spasm and stiffness may result. 

Individuals may find it challenging to twist or engage in activities that involve spinal movement. This restricted range of motion can contribute to discomfort and stiffness in the affected area.

Menopause-Related Spondylolisthesis Symptoms

The onset of menopause may accelerate normal degenerative changes of the lumbar vertebrae, discs, facet joints, and ligaments. 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

Typically, the symptoms associated with this progression include low back pain, stiffness, and/or pain radiating down the leg (sciatica). 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

Read more about Sciatica Symptoms

Diagnosis of Degenerative Spondylolisthesis

Radiating sciatica pain may occur in degenerative spondylolisthesis.

A physician trained in musculoskeletal conditions can help diagnose degenerative spondylolisthesis.

A comprehensive assessment of the patient’s history, past medical history, thorough physical examination, and review of any prior tests and imaging studies are performed.

During the review of patient history and the physical examination, physicians typically check for 7 Akkawi I, Zmerly H. Degenerative Spondylolisthesis: A Narrative Review. Acta Biomed. 2022;92(6):e2021313. Published 2022 Jan 19. doi:10.23750/abm.v92i6.10526 :

• Pain pattern. Physicians ask about localized or radiating pain and the pattern of pain distribution to check if sciatica is present.
• Postural effects. In degenerative spondylolisthesis, pain is exacerbated while bending backward and relieved when bending forward.
• History of symptoms. Neurogenic claudication and hamstring spasm while walking or standing for variable periods of time may indicate spinal stenosis caused by degenerative spondylolisthesis.

If these symptoms and signs are noticed, the physician may order imaging tests to further investigate the condition.

Imaging Tests for Degenerative Spondylolisthesis

X-rays are helpful in diagnosing and assessing the extent of degenerative spondylolisthesis.

Imaging tests may help confirm the diagnosis of degenerative spondylolisthesis and provide evidence of the extent of progression of the condition. 

• Standing lateral radiographs are considered the most reliable and standard test for diagnosing degenerative spondylolisthesis. 7 Akkawi I, Zmerly H. Degenerative Spondylolisthesis: A Narrative Review. Acta Biomed. 2022;92(6):e2021313. Published 2022 Jan 19. doi:10.23750/abm.v92i6.10526
• Flexion-extension radiographs are used to determine if there is any motion of one vertebra upon the other (translation) and/or instability during spinal movements. 7 Akkawi I, Zmerly H. Degenerative Spondylolisthesis: A Narrative Review. Acta Biomed. 2022;92(6):e2021313. Published 2022 Jan 19. doi:10.23750/abm.v92i6.10526
• Magnetic resonance imaging (MRI) scans may be used to check for spinal stenosis, nerve root compression, spinal cord involvement, and disc degeneration. 3 García-Ramos CL, Valenzuela-González J, Baeza-Álvarez VB, Rosales-Olivarez LM, Alpizar-Aguirre A, Reyes-Sánchez A. Degenerative spondylolisthesis I: general principles. Espondilolistesis degenerativa lumbar I: principios generales. Acta Ortop Mex. 2020;34(5):324-328.. , 7 Akkawi I, Zmerly H. Degenerative Spondylolisthesis: A Narrative Review. Acta Biomed. 2022;92(6):e2021313. Published 2022 Jan 19. doi:10.23750/abm.v92i6.10526  Some researchers consider MRI scans as the most reliable test to diagnose spinal stenosis in degenerative lumbar spondylolisthesis. 8 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.
• CT scans are used if bone involvement such as spondylolysis or isthmic spondylolisthesis is suspected, as these scans provide detailed evaluation of bone integrity.

If an MRI is not possible, computed tomography (CT) scans with myelography may be used as an alternative test. 7 Akkawi I, Zmerly H. Degenerative Spondylolisthesis: A Narrative Review. Acta Biomed. 2022;92(6):e2021313. Published 2022 Jan 19. doi:10.23750/abm.v92i6.10526 , 8 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.

MRI scans or CT scans may also be used if severe neurogenic claudication is present, bowel and/or bladder incontinence is reported, and/or tumors are suspected. 

• 1 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
• 2 Li N, Scofield J, Mangham P, Cooper J, Sherman W, Kaye A. Spondylolisthesis. Orthop Rev (Pavia). 2022 Jul 27;14(4):36917. doi: 10.52965/001c.36917. PMID: 35910544; PMCID: PMC9329062.
• 3 García-Ramos CL, Valenzuela-González J, Baeza-Álvarez VB, Rosales-Olivarez LM, Alpizar-Aguirre A, Reyes-Sánchez A. Degenerative spondylolisthesis I: general principles. Espondilolistesis degenerativa lumbar I: principios generales. Acta Ortop Mex. 2020;34(5):324-328..
• 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 Kalichman L, Hunter DJ. Diagnosis and conservative management of degenerative lumbar spondylolisthesis. Eur Spine J. 2008;17(3):327-335. doi:10.1007/s00586-007-0543-3
• 6 Studnicka K, Ampat G. Lumbosacral Spondylolisthesis. [Updated 2022 Sep 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560679/
• 7 Akkawi I, Zmerly H. Degenerative Spondylolisthesis: A Narrative Review. Acta Biomed. 2022;92(6):e2021313. Published 2022 Jan 19. doi:10.23750/abm.v92i6.10526
• 8 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.

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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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.

Non-urgent advice: 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.

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

Page last reviewed: 01 June 2022 Next review due: 01 June 2025

Spondylolisthesis

Spondylolisthesis is slippage of a lumbar vertebra in relation to the vertebra below it. Anterior slippage (anterolisthesis) is more common than posterior slippage (retrolisthesis). Spondylolisthesis has multiple causes. It can occur anywhere in the spine and is most common in the lumbar and cervical regions. Lumbar spondylolisthesis may be asymptomatic or cause pain when walking or standing for a long time. Treatment is symptomatic and includes physical therapy with lumbar stabilization.

There are five types of spondylolisthesis, categorized based on the etiology:

Type I, congenital: caused by agenesis of superior articular facet

Type II, isthmic: caused by a defect in the pars interarticularis (spondylolysis)

Type III, degenerative: caused by articular degeneration as occurs in conjunction with osteoarthritis

Type IV, traumatic: caused by fracture, dislocation, or other injury

Type V, pathologic: caused by infection, cancer, or other bony abnormalities

Spondylolisthesis usually involves the L3-L4, L4-L5, or most commonly the L5-S1 vertebrae.

Types II (isthmic) and III (degenerative) are the most common.

Type II often occurs in adolescents or young adults who are athletes and who have had only minimal trauma; the cause is a weakening of lumbar posterior elements by a defect in the pars interarticularis (spondylolysis). In most younger patients, the defect results from an overuse injury or stress fracture with the L5 pars being the most common level.

Type III (degenerative) can occur in patients who are > 60 and have  osteoarthritis ; this form is six times more common in women than men.

Anterolisthesis requires bilateral defects for type II spondylolisthesis. For type III (degenerative) there is no defect in the bone.

ZEPHYR/SCIENCE PHOTO LIBRARY

Spondylolisthesis is graded according to the percentage of vertebral body length that one vertebra subluxes over the adjacent vertebra:

Grade I: 0 to 25%

Grade II: 25 to 50%

Grade III: 50 to 75%

Grade IV: 75 to 100%

Spondylolisthesis is evident on plain lumbar x-rays. The lateral view is usually used for grading. Flexion and extension views may be done to check for increased angulation or forward movement.

Mild to moderate spondylolisthesis (anterolisthesis of ≤ 50%), particularly in the young, may cause little or no pain. Spondylolisthesis can predispose to later development of foraminal stenosis . Spondylolisthesis is generally stable over time (ie, permanent and limited in degree).

Treatment of spondylolisthesis is usually symptomatic. Physical therapy with lumbar stabilization exercises may be helpful.

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Spondylolisthesis

Spondylolisthesis is a condition where one of the bones in your spine, called a vertebra, slips forward over the bone below it. This can cause back pain and affect your ability to move.  The degree of slippage can worsen over time and lead to other spinal conditions such as neural compression.  This condition can affect spinal stability.

Common Causes

• Degenerative changes: Wear and tear on the spine from aging.
• Birth defects: Some people are born with a defective bone in their spine.
• Injuries: Trauma or stress fractures from sports or accidents.
• Previous surgery: Sometimes spinal surgery can lead to spondylolisthesis.
• Lower back pain.
• Pain that radiates to the buttocks or legs.
• Stiffness in the back.
• Muscle tightness or spasms.
• Numbness or tingling in the legs.
• Weakness in the legs.
• Difficulty walking or standing for long periods.

Diagnostic Tests

• Physical exam: The doctor checks for pain, range of motion, and muscle strength.
• X-rays: Pictures of the spine to see if a vertebra has slipped.
• MRI or CT scan: Detailed images of the spine to see any damage to the discs or nerves.
• Bone scan: A test to detect fractures and other bone changes.

Treatment Options

Non-surgical:.

• Medications: Over-the-counter pain relievers or prescription medications to reduce pain and inflammation.
• Physical therapy: Exercises to strengthen the core muscles and improve flexibility.
• Injections: Steroid injections to reduce inflammation and pain.
• Chiropractic care: Manual adjustments to improve spine alignment.
• Spinal fusion: Joining two or more vertebrae to stabilize the spine, which may include decompression of the nerves if needed.

Common Conditions That Can Cause Similar Symptoms

• Herniated disc: When the inner part of a spinal disc pushes out and presses on a nerve.
• Spinal stenosis: Narrowing of the spaces in the spine, putting pressure on the nerves.
• Sciatica: Pain that travels along the sciatic nerve from the lower back down the leg.
• Degenerative disc disease: When discs break down due to aging or injury.

When to See the Doctor

• If you have persistent back pain.
• If you experience numbness, tingling, or weakness in your legs.
• If the pain interferes with your daily activities or sleep.
• If you have difficulty walking or standing for long periods.

What to Ask the Doctor

• What is causing my symptoms?
• What treatment options are available?
• How long will it take to recover?
• What are the risks and benefits of surgery if needed?
• Are there specific exercises I should do or avoid?

Home Remedies for Mild Symptoms

• Exercise: Gentle exercises can help strengthen back muscles and reduce pain.
• Stretching: Regular stretching can relieve muscle tension and improve flexibility.
• Pain relief: Over-the-counter pain relievers like ibuprofen or acetaminophen can help with pain.
• Proper posture: Maintain good posture to reduce pressure on the spine.
• Heat or ice therapy: Applying heat or ice can reduce pain and swelling.

Understanding spondylolisthesis can help you know when to seek medical advice and what questions to ask your doctor. Early detection and treatment can help manage the condition, prevent worsening, and improve your quality of life.

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Spondylolisthesis.

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In spondylolisthesis, one of the bones in your spine — called a vertebra — slips forward and out of place. This may occur anywhere along the spine, but is most common in the lower back (lumbar spine). In some people, this causes no symptoms at all. Others may have back and leg pain that ranges from mild to severe.

(Left) In spondylolysis, a fracture often occurs at the pars interarticularis. (Right) Because of the pars fracture, only the front part of the bone slips forward.

What are the different types of spondylolisthesis?

Many types of spondylolisthesis can affect adults. The two most common types are degenerative and spondylolytic. There are other less common types of spondylolisthesis, such as slippage caused by a recent, severe fracture or a tumor.

What is degenerative spondylolisthesis?

As we age, general wear and tear causes changes in the spine. Intervertebral discs begin to dry out and weaken. They lose height, become stiff, and begin to bulge. This disc degeneration is the start to both arthritis and degenerative spondylolisthesis (DS).

As arthritis develops, it weakens the joints and ligaments that hold your vertebrae in the proper position. The ligament along the back of your spine (ligamentum flavum) may begin to buckle. One of the vertebrae on either side of a worn, flattened disc can loosen and move forward over the vertebra below it. This can narrow the spinal canal and put pressure on the spinal cord. This narrowing of the spinal canal is called spinal stenosis and is a common problem in patients with DS.

Women are more likely than men to have DS, and it is more common in patients who are older than 50. A higher incidence has been noted in the African-American population.

What is spondylolytic spondylolisthesis?

One of the bones in your lower back can break and this can cause a vertebra to slip forward. The break most often occurs in the area of your lumbar spine called the pars interarticularis.

In most cases of spondylolytic spondylolisthesis, the pars fracture occurs during adolescence and goes unnoticed until adulthood. The normal disc degeneration that occurs in adulthood can then stress the pars fracture and cause the vertebra to slip forward. This type of spondylolisthesis is most often seen in middle-aged men.

Because a pars fracture causes the front (vertebra) and back (lamina) parts of the spinal bone to disconnect, only the front part slips forward. This means that narrowing of the spinal canal is less likely than in other kinds of spondylolisthesis, such as DS in which the entire spinal bone slips forward.

What are the symptoms of degenerative spondylolisthesis?

Patients with DS often visit the doctor's office once the slippage has begun to put pressure on the spinal nerves. Although the doctor may find arthritis in the spine, the symptoms of DS are typically the same as symptoms of spinal stenosis. For example, DS patients often develop leg and/or lower back pain. The most common symptoms in the legs include a feeling of vague weakness associated with prolonged standing or walking.

Leg symptoms may be accompanied by numbness, tingling, and/or pain that is often affected by posture. Forward bending or sitting often relieves the symptoms because it opens up space in the spinal canal. Standing or walking often increases symptoms.

What are the symptoms of spondylolytic spondylolisthesis?

Most patients with spondylolytic spondylolisthesis do not have pain and are often surprised to find they have the slippage when they see it in x-rays. They typically visit a doctor with low back pain related to activities. The back pain is sometimes accompanied by leg pain.

How is a spondylolisthesis diagnosed?

Doctors diagnose both DS and spondylolytic spondylolisthesis using the same examination tools.

After discussing your symptoms and medical history, your doctor will examine your back. This will include looking at your back and pushing on different areas to see if it hurts. Your doctor may have you bend forward, backward, and side- to-side to look for limitations or pain.

Other tests which may help your doctor confirm your diagnosis include:

X-rays. These tests visualize bones and will show whether a lumbar vertebra has slipped forward. X-rays will show aging changes, like loss of disc height or bone spurs. X-rays taken while you lean forward and backward are called flexion-extension images. They can show instability or too much movement in your spine.

Magnetic resonance imaging (MRI). This study can create better images of soft tissues, such as muscles, discs, nerves, and the spinal cord. It can show more detail of the slippage and whether any of the nerves are pinched.

Computed tomography (CT). These scans are more detailed than x-rays and can create cross-section images of your spine.

How is spondylolisthesis treated without surgery?

Although nonsurgical treatments will not repair the slippage, many patients report that these methods do help relieve symptoms.

Physical therapy and exercise . Specific exercises can strengthen and stretch your lower back and abdominal muscles.

Medication . Pain killers and non-steroidal anti-inflammatory medicines may relieve pain.

Steroid injections . Cortisone is a powerful anti-inflammatory. Cortisone injections around the nerves or in the "epidural space" can decrease swelling, as well as pain. It is not recommended to receive these, however, more than three times per year. These injections are more likely to decrease pain and numbness, but will not relieve weakness of the legs.

When should someone with degenerative spondylolisthesis be treated with surgery?

Patients should consider surgery for degenerative spondylolisthesis if they have tried the nonsurgical treatments for 3 to 6 months with no improvement.

Before committing to surgery, your provider will take a close look at the extent of the arthritis in your spine and whether your spine has excessive movement.

DS patients who are candidates for surgery are usually not able to walk or stand, and have a poor quality of life due to the pain and weakness.

When should someone with spondylolytic spondylolisthesis be treated with surgery?

Patients should consider surgery for spondylolytic spondylolisthesis if they have tried the nonsurgical treatments for at least 6 to 12 months with no improvement.

If the slippage is getting worse or the patient has progressive neurologic symptoms, such as weakness, numbness, or falling, and/or symptoms of cauda equina syndrome, surgery may help.

How is spondylolisthesis treated with surgery?

Surgery for both DS and spondylolytic spondylolisthesis includes removing the pressure from the nerves and spinal fusion.

Removing the pressure involves opening up the spinal canal. This procedure is called a laminectomy. Spinal fusion is essentially a "welding" process. The basic idea is to fuse together the painful vertebrae so that they heal into a single, solid bone.

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Spondylolisthesis

What is Spondylolisthesis?

Patient education video.

Types of Spondylolisthesis

What Are the Signs and Symptoms of Spondylolisthesis?

How is it diagnosed.

• Grade I – Less than 25 percent slippage
• Grade II – Between 25 and 50 percent slippage
• Grade III – Between 50 and 75 percent slippage
• Grade IV – More than 75 percent slippage
• Grade V – The upper vertebral body has slipped all the way off the front of the lower vertebral body. This is a rare situation that is called a spondyloptosis.

How is it Treated?

Surgery & treatment for spondylolisthesis, what are you looking for.

Avoid Spinal Fusion

Disc / Facet Replacement

Robotic Spine Surgery

Stem Cell Regeneration

Minimally Invasive Surgery

Spine Rehabilitation

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What Is Spondylolisthesis?

What to do about your slipped vertebra.

When you describe someone who’s tough, sturdy, and strong, people often say that they have a “backbone.” Or if you’re discussing the unshakable core of something, you also might use the word “backbone.” But as it turns out, those metaphors for the spine might not be as realistic as you may think.

Like any part of the body, your spine is prone to its fair share of unsteadiness. Specifically, a condition called spondylolisthesis in which a vertebra moves and slips out of place, causing intense lower back pain among other symptoms. The once stable spinal column is anything but as a result, and it can lead to complications.

The Cleveland Clinic reports that around 4% to 6% of adults live with this condition.

Spondylolisthesis occurs when one vertebra slips forward over the vertebra below it. The term is pronounced spon-duh-low-liss-thee-sis and is derived from the Greek language: spondylo means vertebra and listhesis means to slip .

There are several types or causes of spondylolisthesis; a few are listed below.

Congenital spondylolisthesis means the disorder is present at birth.

Isthmic spondylolisthesis occurs when a defect called a pars fracture occurs in a bony supporting vertebral structure at the back of the spine called the pars interarticularis.

Degenerative spondylolisthesis is more common and is often associated with degenerative disc disease , wherein the discs (e.g., due to the effects of growing older) lose hydration and resiliency and provide less protection.

Any vertebra may slip out of place, but spondylolisthesis tends to be the most common in the lower back. With the vertebrae out of place and without proper positioning, the entire spinal column is out of whack, which can lead to problems if it’s not addressed.

Spondylolisthesis Symptoms

Each form of this condition shares similar symptoms. But often, spondylolisthesis doesn’t present any symptoms at all—it’s asymptomatic, and it may take years to finally develop any symptoms.

These symptoms can include:

Lower back pain

Pain that extends to the buttocks and thighs

Pain that worsens with activity

Stiff muscles, which can include tight hamstrings or muscle spasms in the hamstrings

Difficulty with standing or walking

Tired feeling, tingling, numbness, or weakness in legs

Curvature of the spine, also known as kyphosis

The symptoms show up differently in each person. While one person may complain of low back pain, another may primarily feel pain in their legs.

There are some complications that may arise from spondylolisthesis. The pain in one’s low back and legs can become chronic, along with feelings of numbness, weakness, or tingling. Additionally, infection may occur, or the spinal nerves can be permanently damaged. A less common result of spondylolisthesis can be loss of bladder or bowel control.

How Spondylolisthesis May Develop

The spine is connected to everything else in the body in one way or another. It really carries the brunt of every move we make, from walking to jumping to twisting to micromovements you barely notice.

Medically speaking, this means that the lumbar spine , or the lower region of your spinal column, is constantly exposed to directional pressures while it carries, absorbs, and distributes most of your body's weight at rest and during activity.

In other words, while your lumbar spine is carrying and absorbing body weight, it also moves in different directions (e.g., rotate, bend forward). Sometimes, this combination causes excessive stress to the vertebra and/or its supporting structures (which may already be weak) and may lead to a vertebral body slipping forward over the vertebra beneath.

For a visual, picture riding on a horse. If the horse gets wet or is sweating, the saddle may slip forward more easily. The saddle is on an unstable surface, which causes it to continually slip forward. This would make for a very unsteady riding experience, and the same happens with the spine when spondylolisthesis occurs.

Some people can be more at risk for developing spondylolisthesis than others. For instance, if a family member has spondylolisthesis, your risk for developing the disorder may be greater.

Some activities make you more susceptible to spondylolisthesis. Gymnasts, linemen in football, and weight lifters all put significant pressure and weight on their low backs. Spondylolisthesis can develop as a result of repeated excessive strains and stress.

Degenerative spondylolisthesis is more common in those older than 50 and tends to be diagnosed more often in women than men. Bone disease and fractures —also more common as you age—can additionally lead to spondylolisthesis. Health-wise, a tumor can also result in spondylolisthesis. On the flip side, children can experience spondylolisthesis through a birth defect, athletics (particularly in kids who have overextended their spines), or traumatic injury.

Causes of Spondylolisthesis

There are multiple causes of spondylolisthesis. However, there is a growing consensus that it’s typically the result of instability of the spine in general, and specifically the lumbar spine, the most common type of spondylolisthesis. This spinal instability often leads to pain that radiates to the affected limb.

When the spine is unstable, daily repetitive motions and acute stresses associated with sports or work fatigue the soft tissue structures ( muscles , tendons , and ligaments ) that keep the spine aligned and fully functional. As a result of this instability, the vertebrae become unstable and begin to slip. Then, spondylolisthesis can develop.

Another cause of spondylolisthesis is the development of spinal osteoarthritis . Osteoarthritis causes vertebral bones to degenerate, leading to facet joints that slowly lose their normal structural support. This results in slippage. As a result, spinal discs begin to degenerate further, contributing to the development of spondylolisthesis.

If your doctor suspects spondylolisthesis, they will begin with a discussion about your medical history and when you first noticed the pain. Next, the doctor will perform a physical exam, which usually involves moving the legs to find out where the back pain is originating.

Your doctor will also need to use a differential diagnosis approach, or ruling things out, as they work to reach a conclusion. Spondylolisthesis can also present as general low back pain, spondylolysis (or a pars fracture, a stress fracture in the spine), or a pinched nerve .

If spondylolisthesis is suspected, the doctor will move onto what’s generally considered the best way to diagnose spondylolisthesis—an X-ray.

The X-ray below shows you a good example of a lumbar spondylolisthesis. Look at the area to which the arrow is pointing: You can see that the vertebra above the arrow isn't in line with the vertebra below it. It's slipped forward; it's spondylolisthesis.

Sometimes a CT scan or MRI scan will be used to diagnose spondylolisthesis if a doctor needs to view smaller details of the spine or see the soft tissues, which can include nerves and discs.

There’s also a grading system that doctors use to denote the severity of a spondylolisthesis using five descriptive categories. Although there are several factors your doctor considers when evaluating your spondylolisthesis, the grading scale (below) is based on how far forward a vertebral body has slid forward over the vertebra beneath. Often, the doctor uses a lateral (side view) X-ray to examine and grade a spondylolisthesis. Grade I is a smaller slip than Grade IV or V.

Grade I: Less than 25% slip

Grade II: 25% to 49% slip

Grade III: 50% to 74% slip

Grade IV: 75% to 99% slip

Grade V: The vertebra has fallen forward off the vertebra below it. This is the most severe type of spondylolisthesis and is termed spondyloptosis.

Complications of Spondylolisthesis

As the soft tissues become more unstable and the vertebrae slip and degenerate, nerves are entrapped and irritated, causing pain and discomfort. When this pain becomes chronic, it may prevent people from participating in enjoyable activities and hobbies. It can also interfere with daily domestic tasks, such as cooking, cleaning, and taking care of children and pets. As tasks mount up and there are fewer positive outlets for stress (such as exercise), all of this can result in a lowered quality of life.

If left untreated, spondylolisthesis may lead to lumbar spinal stenosis , a condition in which the spinal canal narrows and compresses the surrounding nerves and blood vessels. Spinal stenosis causes weakness and/or intense chronic pain in the back that often travels down the legs, making it difficult to walk. A diagnosis of spinal stenosis requires the use of imaging technology, such as computed tomography scans or magnetic resonance imaging, to precisely identify the affected areas of the spine as well as the scope of degeneration.

Because of the stresses placed on the vertebrae and the degenerative nature of arthritis, people with spondylolisthesis are at greater risk for lumbar spinal fractures. The risk is even high among older adults and those with osteoporosis. When the vertebrae fractures due to stress, spinal instability is increased, and the compromised facets may irritate the corresponding spinal nerves and cause pain.

If pinched nerves, spinal stenosis, and degenerative arthritis cannot be managed with conservative measures, such as rest, medication, or physical therapy , surgery may be necessary to restore proper function and eliminate debilitating pain. In particular, children with high-grade spondylolisthesis who continually experience radial pain often need surgery.

However, because of the inherent risks associated with spinal surgery, all conservative measures should be exhausted first.

Spondylolisthesis Treatment

If you’re searching for the right spondylolisthesis treatment, there are several options.

Nonsurgical Treatment

Your doctor may want to start with a more conservative approach before moving on to surgery. These options can include:

Rest, or taking a break from activities or sports that have either caused or will continue to exacerbate the condition.

Over-the-counter pain medications , such as acetaminophen or NSAIDs (e.g., ibuprofen). If the pain can’t be lessened by these medications, your doctor may write you a prescription for an oral steroid or administer steroid shots . The goal is to reduce pain and inflammation at the source.

Wearing a back brace , specifically a corset or one that’s geared toward low back pain. However, be cautious as overuse of a back brace is felt to weaken the muscles of the spine.

Physical therapy, which can be one of the most effective ways to treat spondylolisthesis. Techniques like deep tissue massage, TENS (transcutaneous electrical nerve stimulation ), and exercises that focus on core stability and range of motion can help to strengthen the spinal muscles and teach you to prevent even more injury.

Core strengthening

Weight loss

Applying heat and/or ice (ask your doctor for specific recommendations on how long and how often to apply each)

For a medical treatment that lands between conservative approaches and surgery, you could turn to something called regenerative injection therapy, in which a doctor will extract cells from one part of the body and inject them at the site of the spondylolisthesis. These include platelet-rich plasma (PRP) therapy and stem cell therapy and are less invasive than surgery. But be forewarned that while these two treatments are heavily marketed, they remain unproven in scientific research.

Spondylolisthesis Surgery

Let’s say that you’ve tried everything and you’re still experiencing painful symptoms. Or perhaps the severity of your case falls within the higher grades. In this case, your doctor may recommend surgery.

If your spondylolisthesis is stable (does not change with position), you may be a candidate for a simple decompression. This involves removing the bone, cartilage, and/or disc material that is compressing the nerve. This is done through procedures such as:

Foraminotomy

In cases where there is instability, the bones are actively sliding when bending and extending the back. These cases typically require spinal fusion . The goal of fusion is to realign the spine and fixate it in the proper alignment with hardware. The hardware acts to stabilize the segment while bony fusion, or bone growth, across the joint occurs.

The hardware anchors the bones together with screws and rods or plates. A fusion often incorporates a cage which is a spacer used in place of the disc. This provides even greater stability.

The commonly accepted term for this surgery is lumbar interbody fusion (LIF) with an extra word (or letter) at the beginning indicating where your surgeon will make the incision to access your spine:

Anterior (ALIF) —from stomach side

Transforaminal (TLIF) or Posterior (PLIF) —the back side

Oblique (OLIF)—off-center back

Lateral (LLIF)—the side of the spine (under the ribs), which is also known by its brand name, XLIF (Extreme Lateral Interbody Fusion)

While no patient is excited about the prospect of a fusion, the potential for improvement in pain far outweighs the risks of the procedure and the mild to moderate loss of movement attained.

Spondylolisthesis Outlook

The outlook for the majority of those with mild or moderate (low-grade) forms of spondylolisthesis is optimistic. Many people with low-grade spondylolisthesis respond well to a combination of rest, physical therapy, medication, and stretching and strengthening of the lower back.

Lifestyle changes (like getting more exercise, quitting smoking, and improving cardiovascular health) are also important components of managing the pain and complications associated with spondylolisthesis. These measures also help improve recovery should surgery be chosen in the future. Because spinal stability is a core consideration in the management and treatment of spondylolisthesis, any nonoperative measures should aim at strengthening the core muscles that support the spine.

Although spinal surgery carries inherent risks and involves significant recovery time for those with high-grade spondylolisthesis, it often allows younger people with severe spinal issues to improve their quality of life, especially in light of evolving surgical options. Older patients, and in particular those with complications such as osteoporosis, have more risks associated with spinal surgery. Because of this, outlook is improved when spondylolisthesis is diagnosed and treated early in the course of the disease, before these complications arise.

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Yi Xiang, J., Wang, Zoltán Káplár, Min Deng, Jason, et al. “Lumbar degenerative spondylolisthesis epidemiology: A systematic review with a focus on gender-specific and age-specific prevalence.” Journal of Orthopaedic Translation , Volume 11, 2017, Pages 39-52, ISSN 2214-031X, https://doi.org/10.1016/j.jot.2016.11.001.

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Deer, T., Sayed, D., Michels, J., et al. “A Review of Lumbar Spinal Stenosis with Intermittent Neurogenic Claudication: Disease and Diagnosis.” Pain Med. 2019 Dec 1;20(Suppl 2):S32-S44. doi: 10.1093/pm/pnz161. PMID: 31808530; PMCID: PMC7101166.

Wang, P., Wang F., Gao Y.L., et al. “Lumbar spondylolisthesis is a risk factor for osteoporotic vertebral fractures: a case-control study.” J Int Med Res. 2018 Sep;46(9):3605-3612. doi: 10.1177/0300060518776067. Epub 2018 May 29. PMID: 29808735; PMCID: PMC6136001.

Metzger, R., Chaney, S. “Spondylolysis and spondylolisthesis: What the primary care provider should know.” Wiley Online Library. https://journals.lww.com/jaanp/Abstract/2014/01000/Spondylolysis_and_spondylolisthesis__What_the.3.aspx Published October 1, 2013. Accessed September 27, 2022.

Cavalier, R., Herman, M.J., Cheung, E.V., et al. “Spondylolysis and spondylolisthesis in children and adolescents: I. Diagnosis, natural history, and nonsurgical management.” J Am Acad Orthop Surg. 2006 Jul;14. doi:10.5435/00124635-200607000-00004.

Williams, Keith D. Campbell's Operative Orthopaedics, 14th Edition. Chapter 40, Spondylolisthesis, 1802-1831.e1, 2021. https://www.clinicalkey.com/#!/content/book/3-s2.0-B9780323672177000407?scrollTo=%23hl0000985

Lionel, N., Metz, B.S., Vedat, D. “Neurosurgery Clinics of North America, Volume 18, Issue 2: Low-Grade Spondylolisthesis,” Pages 237-248, https://www.clinicalkey.com/#!/content/journal/1-s2.0-S1042368007000216

Studnicka, K., Ampat, G. “Lumbar Stabilization.” [Updated 2021 Nov 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK562179/?report=classic

Goh, G.S., Tay, Y.W.A., Yue, W.M., et al. “What Are the Patient-reported Outcomes, Complications, and Radiographic Results of Lumbar Fusion for Degenerative Spondylolisthesis in Patients Younger Than 50 Years?” Clin Orthop Relat Res. 2020 Aug;478(8):1880-1888. doi: 10.1097/CORR.0000000000001252.

Bice, M., Anderson, Paul A. “Benzel's Spine Surgery, Fifth Edition. Chapter 8: Bone Physiology and Osteoporosis.” https://www.clinicalkey.com/#!/content/book/3-s2.0-B9780323636681000082?scrollTo=%23hl0000350

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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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Medical Professionals

Professional Reference articles are designed for health professionals to use. They are written by UK doctors and based on research evidence, UK and European Guidelines. You may find the  Cervical spondylosis  article more useful, or one of our other  health articles .

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.

Article history

The information on this page is written and peer reviewed by qualified clinicians.

Next review due: 19 Nov 2026

20 nov 2021 | latest version.

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Spondylolisthesis

We design a unique treatment plan for your condition of spondylolisthesis and take into account your life goals.

What is spondylolisthesis?

Low back pain, leg pain and weakness in the legs can happen if the bone that’s out of position significantly narrows the spinal column and begins to press on nerves.

Causes of spondylolisthesis

• Birth defect of the vertebral joint – This usually occurs in the lower spine where the lumbar spine and sacrum come together
• Stress “micro-fracture” in the bone due to overstretching and overuse – This can occur with sports activities such as gymnastics, weight lifting, ice skating and football
• Aging or overuse-related wear on the spinal joints

Rest and anti-inflammatory medication resolve most cases.

If it’s more severe, you may need physical therapy or surgery.

Spondylolisthesis grades

Doctors commonly describe spondylolisthesis as either high-grade or low-grade, depending on how severe your condition is. Grades are from 1 to 4.

• Low-grade (grade 1 and grade 2) usually occurs in adolescents and is considered less severe. Low-grade doesn’t typically require surgery.
• High-grade (grade 3 and grade 4) may require surgery if you’re experiencing severe pain.

The grade of your condition is based on how far away from proper alignment your spine has become.

Spondylolisthesis symptoms

In many cases, people who have spondylolisthesis don’t have any symptoms. You may not be aware you have the condition until an X-ray is taken for an unrelated reason. If you do have symptoms, the most common are:

• Lower back pain that feels like a muscle strain
• Muscle spasms or tightness in your hamstring
• Lower back pain that worsens with activity and improves with rest
• Difficulty walking or standing
• Pain when bending over
• Stiffness in your back
• Pain extending down from your lower back to your thighs

If you have high-grade spondylolisthesis, you may experience tingling, numbness or weakness in one or both legs.

Diagnosing spondylolisthesis

Following a thorough medical history, physical and neurological exams, our spine surgeons may recommend any of the following tests to confirm whether a bone in your spine is out of alignment. All tests are available at Ohio State Spine Care :

• Computed tomography (CT) scan
• Magnetic resonance imaging (MRI) scan
• Electromyography (EMG) to test your muscles and nerves

Spondylolisthesis treatment

Ohio State’s Spine Care team has the benefit of extra expertise from treating many people with spondylolisthesis. Because of this, the Spine Care team, composed of orthopedic and neurological specialists, is uniquely qualified to determine whether you’re likely to benefit from nonsurgical treatment. We also recommend lifestyle changes to prevent future problems with your spine.

We offer treatments ranging from physical therapy to the most complex spine surgeries. Physicians, therapists and other care providers work together to provide you with options that increase mobility and reduce pain.

Most people who come to Ohio State Spine Care don’t require surgery.

Lifestyle changes

• Exercise, such as Pilates or yoga, to strengthen muscles in your back
• Quitting smoking
• Guidance on weight loss to reduce pressure on your spine

Nonsurgical treatments

• Physical therapy – We’ll work with you one-on-one to customize a treatment plan for your needs and goals
• Spine orthobiologics use substances in your body to activate the healing process naturally
• Wearing a back brace to limit spine movement
• Medication for pain management

Most people return slowly to full function, including athletic activity.

Spondylolisthesis surgery

You may need surgery if a spinal bone that has slipped is likely to cause damage to nerves and the surrounding spinal structure, or if it’s causing severe pain or muscle weakness in one or both legs.

Our surgeons can perform minimally invasive surgery to correct the symptoms of spondylolisthesis. The surgeon makes tiny incisions in the back and works through a tube to minimize skin and muscle damage, reduce blood loss and reduce postsurgical pain.

At Ohio State, we can use both minimally invasive surgery and conventional surgical techniques for these procedures:

• Decompression surgery (laminectomy) to remove part of the vertebra and relieve pressure on your spinal cord or nerves
• Spinal fusion surgery to fuse a severely slipped bone with the vertebra below it and restore stability to the spinal column

Most people who have decompression or fusion surgery can return to full function, including athletic activities.

Ohio State conducts innovative research in the laboratory, as well as through clinical trials.

Those who have a pinched nerve may be eligible to participate in one of the following areas of research at The Ohio State University Wexner Medical Center.

Biomechanical testing:  We’re doing biomechanical testing to assess the spine before and after surgery. A specialized vest helps us assess your spinal movement and measure the effectiveness of surgery. It ultimately may provide valuable information about which treatment methods will best increase mobility and function of the spine.

Back pain consortium:  We’re members of the International Consortium for Health Outcomes Measurement (ICHOM). Membership in this elite organization allows us to engage with other top U.S. medical centers in global research studies on back pain. As we measure our results against established international standards, we share best practices and elevate our standard of care.

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