Spondylolisthesis: Causes, Symptoms and Treatment

Spondylolisthesis is a condition in which one of the bones of the spine, a vertebra, slips forward out of line with the one below it. It happens most often in the lower back, though it can also affect the neck, and for many people it causes few or no symptoms. When it does cause problems, the most common is lower back pain, sometimes with pain that travels into the buttocks or legs if the slipped vertebra presses on a nearby nerve. The good news is that many cases are manageable, and many people find relief without surgery.

If you have lower back pain that is not going away, understanding what is behind it is the first step. The board-certified and fellowship-trained spine specialists at Resurgens Orthopaedics diagnose and treat spondylolisthesis at locations across metro Atlanta.

What Is Spondylolisthesis?

The spine is a stack of bones called vertebrae, cushioned by discs and held in line by joints, ligaments and muscles. In spondylolisthesis, one vertebra slides forward over the one beneath it, which can narrow the space through which the nerves pass. The condition is most common in the lumbar spine, the lower back, which carries much of the body’s weight. Physicians grade spondylolisthesis by how far the vertebra has slipped, from a mild slip to, rarely, a complete one. A related term, spondylolysis, refers to a small stress fracture in a vertebra that can precede a slip, so the two terms are connected but not the same.

Types and Causes of Spondylolisthesis

Spondylolisthesis is usually grouped by what causes the vertebra to slip. The two most common types in adults are:

Degenerative Spondylolisthesis: Age-related wear of the discs and joints that allows a vertebra to shift, most often in older adults
Isthmic Spondylolisthesis: A slip that follows a small stress fracture in a bridge of bone called the pars interarticularis, often linked to repeated stress on the lower back from sports earlier in life

Less commonly, a vertebra can slip because a disease such as a tumor or osteoporosis has weakened the bone. Activities that repeatedly stress or extend the lower back, such as gymnastics, football and weightlifting, can contribute to the type that follows a stress fracture.

Spondylolisthesis Symptoms

Spondylolisthesis does not always cause symptoms, and many patients remain symptom-free or see little progression over time. Sometimes the slip is found by chance on an X-ray taken for another reason. When symptoms do occur, they often include:

Lower Back Pain: Pain that worsens with activity, standing or bending backward
Relief When Leaning Forward: Back pain that eases when sitting or bending forward
Radiating Symptoms: Pain, numbness or tingling that travels into the buttocks or down a leg
Tightness: Tight hamstrings and stiffness in the lower back
Leg Weakness: Weakness in a leg, or difficulty standing or walking for long periods

Please Note: Spondylolisthesis is usually not dangerous, and a mild slip often needs little more than monitoring. New or worsening leg weakness, numbness or any loss of bladder or bowel control is different and needs prompt medical attention, so contact a physician right away if those occur.

Cervical Spondylolisthesis

Although spondylolisthesis is far more common in the lower back, a vertebra can also slip in the neck, which is called cervical spondylolisthesis. In the neck, it may develop with age-related wear, and it can cause neck pain and stiffness, sometimes with symptoms in the shoulders or arms if a nerve is affected. It is worth noting that cervical spondylolisthesis is a different condition from cervical spondylosis, which is arthritis of the neck, even though the names sound alike.

How Spondylolisthesis Is Diagnosed

A spine specialist can usually diagnose spondylolisthesis with an examination and imaging. Your physician will ask about your symptoms and what makes them better or worse, check your movement and look for tight hamstrings. An X-ray shows the slipped vertebra and how far it has moved, and flexion and extension views, taken while you bend forward and backward, can reveal whether the segment is unstable. When there are signs of nerve pressure, an MRI or CT scan gives a more detailed look at the nerves, discs and bone.

Spondylolisthesis Treatment

Treatment depends on the type of slip, how far the vertebra has moved and whether nerves are affected. Most people start with nonsurgical care, and surgery is usually reserved for slips that are severe, getting worse or causing significant nerve symptoms.

Nonsurgical Treatment

Nonsurgical treatment is successful for most patients with degenerative or isthmic spondylolisthesis. Conservative care may include:

Activity Changes: A short period of modified activity to settle a painful flare
Physical Therapy: Core and back strengthening that supports the spine, a key part of treatment
Medication: Over-the-counter anti-inflammatory medication to ease pain
Bracing: A back brace in some cases to support the spine for a time
Injections: An epidural steroid injection to calm inflammation around an irritated nerve when needed

Surgical Treatment

When nonsurgical care does not relieve symptoms, or when the slip is high-grade, progressing or pressing on nerves, your physician may discuss surgery. The goals are to take pressure off the affected nerves and to stabilize the spine. This often involves a decompression, such as a laminectomy, to free the nerves, frequently combined with a spinal fusion that joins the affected vertebrae so they no longer slip, sometimes using screws and rods to hold them while they heal. Your Resurgens spine surgeon will explain which approach fits your situation and what recovery would involve.

Schedule an Appointment for Back Pain

If lower back pain or leg symptoms are interfering with your daily life, a spine specialist can find the cause and help you feel better. Book an appointment online today with Resurgens Orthopaedics or call us at (404) 847-9999.

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