What Is Spondylolisthesis?
Spondylolisthesis is a condition of the spine. It happens when one of your vertebrae moves more than it should and slips out of place. It usually happens at the base of the spine. When the slipped vertebra puts pressure on a nerve, it can cause pain in your lower back or legs.
Sometimes, people with spondylolisthesis don’t notice anything is wrong. Symptoms include:
- Lower back pain
- Muscle tightness and stiffness
- Pain in the buttocks
- Pain spreading down the legs (due to pressure on nerve roots)
- Pain that gets worse with activity
- Tight hamstrings
- Trouble standing or walking
Spondylolisthesis Causes and Risk Factors
There are six main types of spondylolisthesis. The type you have is determined by the cause. The types include:
- Congenital spondylolisthesis. A vertebra is defective from the time a person is born.
- Isthmic spondylolisthesis. This is caused by another condition called spondylolysis. In spondylolysis, a fracture, or crack, in the thin part of a vertebra can result in vertebrae slipping backward, forward, or over a bone below.
- Degenerative spondylolisthesis. Over time, the disks that cushion vertebrae dry out and get thinner. This thinning makes it easier for a vertebra to slip out of place.
- Traumatic spondylolisthesis. An injury or trauma causes a vertebra to slip out of place.
- Pathological spondylolisthesis. Another condition such as osteoporosis or cancer causes it.
- Post-surgical spondylolisthesis. A vertebra slips out of place after spinal surgery.
Spondylolisthesis is more likely if you:
- Are an athlete. It’s especially common in kids who do gymnastics or play football.
- Were born with thinner areas of vertebrae that are prone to breaking and slipping
- Are older
- Have a degenerative spinal condition
If your doctor thinks you might have spondylolisthesis, they’ll ask about your symptoms and run imaging tests to see if a vertebra is out of place. These imaging tests may include:
Your doctor may give you a grade based on how severe the spondylolisthesis is. Low-grade (I or II) is less serious and usually doesn’t need surgery. High-grade (III and IV) is more serious. You may need surgery, especially if you’re in a lot of pain.
Spondylolisthesis is treated with the strengthening of supportive abdominal and back muscles through physical therapy. Treatment may include:
- Anti-inflammatory medicines, including ibuprofen or naproxen
- Steroid shots
- Physical therapy
If you continue to have severe pain and disability after physical therapy, surgery may be an option.
If you have surgery, they’ll remove bone and disk from your spine to give your nerve more room and to stop the pain. This step is called spinal decompression. Next, they’ll fuse your affected vertebrae to prevent them from slipping again.
Serious spondylolisthesis sometimes leads to another condition called cauda equina syndrome. This is a serious condition in which nerve roots in part of the lower back called the cauda equina get compressed. It can cause you to lose feeling in your legs. It also can affect the bladder. This is a medical emergency. If left untreated, cauda equina syndrome can lead to a loss of bladder control and paralysis.
Sometimes, spondylolisthesis comes back a second time. This happens more often when the spondylolisthesis is a higher grade. If you’ve had surgery for spondylolisthesis, you’ll most likely do well. Most people get back to normal activities within a few months of surgery. But your spine won’t be as flexible as it was before.