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Understanding Spondylolisthesis

Introduction to Spondylolisthesis

Spondylolisthesis is when one vertebra slides forward on another.

Types of Spondylolisthesis

There are many types, including:

  • Degenerative spondylolisthesis is a disease of older adults that develops as a result of facet arthritis and joint remodelling. Joint wear, disc collapse and ligament infolding may result in slippage of a vertebra. Degenerative forms are more likely to occur in women, persons older than fifty, and African Americans. With the slippage, the nerves in the spinal canal become compressed, causing leg and buttock pain.
  • Isthmic anterolisthesis is caused by a defect within the bridge of bone between its upper and lower joints (pars interarticularis) but it can also be seen with an elongated pars. This mostly occurs as a fracture during adolescent years which mostly settles down but can, at some point, slip further and/or cause leg pain.
  • Traumatic anterolisthesis is rare and results from acute fractures in the neural arch, other than the pars. An example of this is in the cervical spine at C2.
  • Dysplastic anterolisthesis results from congenital abnormalities of the upper sacral facets or inferior facets of the fifth lumbar vertebra.
  • Pathologic anterolisthesis is caused by either infection or a malignancy.
  • Post-surgical/iatrogenic anterolisthesis is caused by complications after surgery.

Common Locations and Symptoms

It is most common at the low lumbar spine. It can be present without causing any symptoms whatsoever. In fact, about 50% or more of people who have this condition are unaware. It only requires treatment if it is causing symptoms. In the growing child, it is important that if it is detected, they are medically observed to the end of growth.

Degree of Slippage

The degree of forward slippage determines the ‘degree’ of the slip. The amount of slippage may be graded as ‘high ‘ grade or ‘low’ grade. Usually, the worse the spondylolisthesis, the more likely that it is to cause pain. This can occur early in life where the bone elongates as a result of a stress fracture, thus usually catching the L5 nerve root where it leaves the spine and causes leg pain (Isthmic Spondylolisthesis). More commonly, degenerative spondylolisthesis occurs with age and affects the nerves contained within the spinal canal (similar to spinal stenosis). Both of these types of spondylolisthesis (Isthmic and Degenerative) can affect both sides of the spine, but occasionally affect one side more than the other. Other spondylolisthesis conditions are rare, including congenital or traumatic cases.

High Grade vs. Low Grade Slippage

The high-grade slippage of grades 3-5 (more often Isthmic) is much less common than grades 1-2 (more often Degenerative or Isthmic).

Relationship with Spinal Stenosis

Degenerative spondylolisthesis is closely related to spinal stenosis and is described separately.


Who Gets Spondylolisthesis?

Between 4 - 8% of the population will have it. It is sometimes detected as an accidental finding on medical imaging. About half of people with the condition will experience back pain sometimes also causing leg pain. It seems more common in athletes and women. It will sometimes be a cause of back pain in young people.

What causes Spondylolisthesis?

There are differences in frequency of occurrence with regard to gender and ethnic origin, so it is thought to be mainly genetic.

This image demonstrates Isthmic Spondylolisthesis.

Diagnosing Spondylolisthesis: Symptoms and Imaging

Common Symptoms of Spondylolisthesis

  • Back pain and radiating leg pain are common symptoms.
  • Tight hamstring muscles.
  • There may be an altered body posture.
  • There may also be a scoliosis present as sometimes the bone, as well as slipping forward, can slip sideways (lateral listhesis).

X-ray Imaging for Spondylolisthesis

X-rays will often be done and are best performed in the standing position. This is to assess the upright alignment and to help ‘grade’ the degree of slippage, and to determine what type of spondylolisthesis is present.

MRI Scans for Spondylolisthesis

In young people, radiation exposure with x-rays should be avoided when possible. The current investigation of choice is an MRI scan. This is usually done with the patient lying down, so sometimes the slippage is less obvious.

CT Scans in Spondylolisthesis Diagnosis

A CT scan is sometimes requested by a specialist.

Treatment Options and Considerations for Spondylolisthesis

Conservative Treatments for Spondylolisthesis

  • Sometimes no treatment is required at all if there are no symptoms.
  • Maintaining general fitness with cross-training exercises while acute pain settles is important.
  • Pain control for acute flares of symptoms allows one to maintain a fairly normal lifestyle. Exercises and exercising may help.

Injection Treatments for Spondylolisthesis

Injection treatments will sometimes help establish that the spondylolisthesis is the cause of the symptoms.

Spinal Surgery for Spondylolisthesis

Spinal surgery can have a role in treatment and usually would involve a fusion operation with bone graft. If there is nerve pain, it can be decompressed at the same time. There are many different variations of the operations that are performed and the specifics of surgery are best discussed with your clinician.

EUROSPINE is a society of spine specialists of various disciplines with a large knowledge of spine pathologies. All well-known and accepted treatment modalities for spine pathologies are represented by the members of the society. However, the Society cannot accept any responsibility for the use of the information provided; the user and their health care professionals must retain responsibility for their health care management.

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