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Spondylolisthesis: Overview
Spondylolisthesis is a condition in which one vertebra slips forward over the one beneath it. This slippage can be present at birth (congenital), develop from physical stress on the spine, or result from age-related degeneration. Over time, it may lead to a gradual deformity of the lower spine and narrowing of the spinal canal, often causing back pain, leg pain, and other related symptoms.
What Causes Spondylolisthesis?
Spondylolisthesis happens when one vertebra slips forward over the one below it. The condition may be present at birth (congenital), develop from repeated physical stress on the spine, or result from age-related degeneration. Over time, it can cause gradual changes in the lower spine, narrowing of the spinal canal, and symptoms such as back pain, leg pain, and other discomforts.
The Five Types of Spondylolisthesis
- Type I is called dysplastic spondylolisthesis and is secondary to a congenital defect
of either the superior sacral or inferior L5 facets or both with gradual slipping of the
L5 vertebra. - Type II, also called isthmic or spondylolytic spondylolisthesis, involves a defect in the isthmus (pars interarticularis) and is most significant in people under age 50. When a defect is present but no vertebral slippage has occurred, the condition is known as spondylolysis. If a vertebra slips forward over the one below it (horizontal translation), it is classified as spondylolisthesis.
- Type III, or degenerative spondylolisthesis, develops from wear and tear of the lumbar facet joints. Changes in these joints can allow the vertebra to shift forward or backward, most commonly in older adults. Unlike other types, there is no defect in the pars interarticularis, and the degree of slippage typically does not exceed 30%.
- Type IV, traumatic spondylolisthesis, is associated with acute fracture of a posterior element (pedicle, lamina or facets) other than the pars interarticularis.
- Type V, or pathologic spondylolisthesis, develops when a disease process—such as a tumor or other bone disorder weakens the structural integrity of the bone, allowing one vertebra to slip.
Symptoms
What Are The Symptoms of Spondylolisthesis?
The most common symptom of spondylolisthesis is low back pain. In many cases, the underlying defect (spondylolysis) may develop in childhood, often between ages five and seven, but symptoms may not appear until adulthood. A sudden twisting or lifting motion in the mid-30s can trigger an acute episode of back and leg pain.
Pain patterns include:
- Often relieved by extending the spine
- Worsened by bending forward (flexion)
- Not directly related to the degree of vertebral slippage
About half of patients report that their symptoms began after an injury. In addition to back pain, many also experience leg pain, which may result from narrowing around the nerves exiting the spinal canal, causing irritation of a nerve root.
Other common signs include:
- Vague or mild symptoms with little visible deformity in early stages
- Tight hamstring muscles in the legs (often the first physical sign)
- Visible spinal deformity only when slippage exceeds 50% of the vertebral body’s width
- A small dimple at the site of the abnormality in some cases
- Mild muscle spasms and localized tenderness in the affected area
Diagnosis
How Is Spondylolisthesis Diagnosed?
To determine whether spondylolysis is the source of your symptoms, your doctor will usually begin with a physical examination and may recommend imaging tests such as an X-ray, CT (computed tomography) scan, or MRI (magnetic resonance imaging).
If spondylolisthesis is present, it is diagnosed by observing that one vertebra has shifted forward in relation to the one below it. The condition is also graded based on how far the vertebra has slipped forward:
- Grade I: Less than 25% of the vertebral body width
- Grade II: 25% to 50%
- Grade III: 50% to 75%
- Grade IV: More than 75%
- Grade V (spondyloptosis): The vertebral body has completely shifted off the one beneath it
Treatment
What Is the Treatment For Spondylolisthesis?
Your doctor will explain your diagnosis and review the available treatment options. For most patients without signs of nerve compression or neurological problems, the first approach usually involves non-surgical care, such as:
Non-Surgical Treatments
- Medications
- Rest and activity modification
- Physical therapy
- Bracing
- Epidural steroid injections – may temporarily decrease nerve irritation and reduce pain
Advanced Surgical Procedures
Surgery is generally considered only if conservative treatments fail to provide lasting relief over time, or if nerve-related symptoms develop, such as numbness, tingling, muscle weakness, or bowel and bladder changes.
Procedures that may be recommended for treating spondylolisthesis include:
- Decompression (Laminectomy): Removes bone or tissue pressing on the nerves, relieving pain, numbness, or leg weakness.
- Spinal Fusion: Joins two or more vertebrae together to stabilize the spine and prevent further slippage
- Minimally Invasive Fusion: Uses smaller incisions and advanced techniques to reduce muscle damage, blood loss, and recovery time.
Surgery Option
When Is Surgery Needed for Spondylolisthesis?
Surgery for spondylolisthesis is typically considered only when non-surgical treatments, such as medication, physical therapy, or injections, fail to provide relief, or when symptoms become more severe. It may be necessary if nerve compression leads to numbness, tingling, leg weakness, or changes in bowel or bladder control. In some cases, surgery is also recommended when significant slippage or spinal instability develops, in order to restore alignment, relieve pressure on the nerves, and improve overall function.
Why Choose FASO for Spondylolisthesis?
At Florida Advanced Spine and Orthopedics (FASO), our team combines expertise, advanced technology, and compassionate care to help patients manage spondylolisthesis effectively. Our board-certified spine specialists provide accurate diagnosis using state-of-the-art imaging and offer a full spectrum of treatments, from non-surgical therapies to minimally invasive procedures. We focus on personalized care plans that reduce pain, restore mobility, and improve quality of life. With multiple convenient Florida locations, a proven record of successful outcomes, and a commitment to guiding patients through every step of their recovery, FASO is a trusted partner in spine health.
- Board-certified orthopedic spine surgeons
- Leading technology and diagnostics
- Personalized care plans
- Accredited surgery centers
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Dr. Andrew Corbett, D.O.
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Dr. Jacob Choi, DO
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Dr. Rushad Juyia, DO
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Dr. Eric Berryman, DO
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