Spondylolisthesis

Spondylolisthesis is a spine condition in which one vertebra slips forward over the vertebra beneath it. It most often affects the lower back, or lumbar spine, where the spine carries much of the body’s weight and supports bending, lifting and walking.

The slippage may be mild and cause few symptoms, or it may irritate nearby nerves and contribute to pain, stiffness, weakness, numbness or leg pain. Some people with spondylolisthesis also have related spine conditions, such as spinal stenosis, sciatica or herniated disc, which can influence diagnosis and treatment planning.

Spondylolisthesis can develop for different reasons. Understanding the type helps your care team identify the cause of the slippage and recommend the most appropriate treatment.

Common types include:

• Degenerative spondylolisthesis: Related to age-related wear and tear in the discs, joints and ligaments that support the spine
• Isthmic spondylolisthesis: Often caused by a stress fracture or defect in a small section of bone called the pars interarticularis
• Congenital spondylolisthesis: Present from birth because of how the spine formed during development
• Traumatic spondylolisthesis: Caused by an injury that affects spinal stability
• Pathologic spondylolisthesis: Related to a disease process that weakens bone or spinal structures

Symptoms of spondylolisthesis vary based on how much the vertebra has slipped and whether nearby nerves are compressed. Some people have no symptoms and learn about the condition during imaging for another concern.

When symptoms occur, they may include:

• Lower back pain
• Muscle tightness and stiffness
• Pain that worsens with standing or walking
• Pain that improves with sitting
• Pain that travels into the buttocks or legs
• Numbness, tingling or weakness caused by nerve irritation

These symptoms may overlap with conditions such as sciatica or spinal stenosis.

Spondylolisthesis may result from changes in the spine that develop slowly over time or from a structural weakness that places stress on the vertebrae. In adults, degenerative changes are a common cause, especially when the discs and facet joints lose height and stability.

Risk factors may include aging, repetitive spine extension, participation in certain sports, previous spine injury, family history, arthritis, disc degeneration and conditions that change spinal alignment. Spondylolisthesis can also occur alongside herniated disc or spinal stenosis, which may increase pressure on nerves and worsen symptoms.

Your care team will begin with a medical history and physical exam. They may ask when symptoms started, what activities make pain better or worse, and whether you have leg pain, numbness, weakness or changes in walking.

Diagnostic testing may include X-rays to evaluate spinal alignment and measure the degree of slippage. Flexion and extension X-rays may show whether the vertebra moves abnormally. MRI can help assess nerves, discs and soft tissues, especially when symptoms suggest nerve compression. CT imaging may be used to evaluate bone detail, including stress fractures or other structural changes.

Treatment depends on the severity of the slippage, the level of pain, nerve involvement and how symptoms affect daily life. Many people improve with nonsurgical treatment, especially when the condition is mild or moderate and there is no progressive nerve weakness.

Nonsurgical care may include:

• Activity modification
• Physical therapy
• Core-strengthening exercises
• Anti-inflammatory medicine
• Bracing in select cases
• Image-guided injections
• Epidural injection
• Nerve blocks

Surgery may be considered if pain persists despite conservative care, the slippage progresses, spinal instability is present or nerve compression causes significant weakness, numbness or walking difficulty.

Surgical options may include:

• Decompression procedures such as laminectomy to relieve nerve pressure
• Fusion procedures to stabilize the affected spinal segment
• Minimally invasive approaches, including minimally invasive spinal fusion

Untreated or worsening spondylolisthesis can lead to ongoing back pain, reduced mobility, nerve compression and pain that travels into the legs. In more advanced cases, nerve pressure may cause weakness, numbness, balance problems or difficulty walking.

Severe nerve compression is uncommon but can become urgent if symptoms include loss of bladder or bowel control, numbness in the groin area or sudden weakness. These symptoms require immediate medical evaluation.

Not every case of spondylolisthesis can be prevented, especially when it is related to anatomy, aging or inherited factors. However, healthy spine habits may reduce stress on the lower back and help prevent symptom flare-ups.

Helpful strategies include:

• Maintaining a healthy weight
• Strengthening core and hip muscles
• Using proper lifting techniques
• Avoiding repetitive hyperextension when possible
• Staying active with low-impact exercise
• Addressing back pain early before symptoms worsen

People with known spine conditions should follow their care plan and avoid activities that increase pain or leg symptoms.

If you have persistent lower back pain, leg pain, numbness or weakness, a spine specialist can help determine whether spondylolisthesis or another spine condition is contributing to your symptoms.

To schedule a visit with a Baptist Health Brain & Spine Care provider, fill out an appointment request form or call 833-596-3876.