Spondylolisthesis means one vertebra in your spine has slipped forward over the one below it, and most people who have it improve without surgery.
It’s a long word for a common finding. Many people first see it on an X-ray or MRI report and worry that something in their back is “broken.” In most cases, that isn’t what’s happening.
What causes it?
The two types I see most often in adults are:
Degenerative spondylolisthesis. Over time, wear on the discs and the small facet joints lets a vertebra gradually slide forward. It is most common in the lower back, especially at the L4-L5 level, and in people over 50.
Isthmic spondylolisthesis. A small stress fracture in a thin bridge of bone at the back of the vertebra (called a pars defect, or spondylolysis) allows the bone to slip. This often begins in the teen years and may not cause symptoms until much later.
What does it feel like?
Many people with spondylolisthesis have no symptoms at all. When symptoms do occur, they may include:
Low back pain that is worse with standing or walking
Pain, numbness, or tingling that travels into the buttocks or legs
Leg heaviness or fatigue with walking that eases when you sit or lean forward
The leg symptoms happen when the slip narrows the space around the nerves, a condition called spinal stenosis.
Spondylolisthesis is graded by how far the vertebra has slipped. But the grade on an imaging report doesn’t always match how someone feels, so I focus on your symptoms and exam, not just the picture.
How is it treated?
Treatment usually starts without surgery. Physical therapy to strengthen the core and improve flexibility, activity changes, anti-inflammatory medications when they’re safe for you, and sometimes an epidural steroid injection can all help.
Surgery is considered when leg pain, numbness, or weakness persists despite a good course of nonsurgical care, when symptoms are getting worse, or when they keep you from daily activities. Surgery usually involves relieving pressure on the nerves (decompression), often combined with a fusion to stabilize the slipped segment. Depending on the situation, this can often be done with minimally invasive techniques.
One important exception: new loss of bladder or bowel control, or numbness in the groin or inner thighs, needs emergency evaluation right away.
If you’d like to talk through your options, request an appointment at Virtua Reconstructive Orthopaedics in Sewell or Cherry Hill, or call (609) 267-9400.
This article is for general education and is not medical advice.
