Spondylolisthesis

Spondylolisthesis is a spinal condition where one vertebra slips forward over the bone below it. This misalignment can put pressure on the spinal nerves, leading to back pain, stiffness, or nerve symptoms in the legs. It is a common cause of lower back pain in both young and older adults. With the right treatment, most people manage symptoms effectively and return to normal activities.

What Causes Spondylolisthesis?

Spondylolisthesis develops when the supporting structures of the spine weaken or fracture, allowing one vertebra to shift out of place.

Common causes include:

• Spondylolysis: Stress fractures from repetitive activity (common in gymnasts, football players, and weightlifters)
• Degenerative changes in older adults from arthritis or disc wear and tear
• Congenital defects with abnormal spine formation
• Trauma or injury to the back
• Complication from spinal surgery
• Tumors or diseases that weaken spinal bones

What Are the Symptoms?

Symptoms depend on the severity of the slippage and whether nerves are compressed. They may include:

• Lower back pain that worsens with activity or prolonged standing
• Stiffness and reduced flexibility in the lower back
• Pain radiating to the buttocks or legs
• Numbness, tingling, or weakness in the legs
• Tight hamstrings that make it hard to bend forward
• Changes in walking or posture

Some people may have no symptoms and discover spondylolisthesis only through imaging tests.

When Should I See a Specialist About Spondylolisthesis?

You should contact a spine specialist if you experience:

• Persistent lower back pain lasting more than a few weeks
• Pain radiating into the legs or buttocks
• Weakness, tingling, or numbness in the legs
• Trouble walking or standing for long periods
• A history of sports-related back injuries with ongoing pain

Prompt evaluation helps prevent progression and nerve damage.

How Is Spondylolisthesis Diagnosed?

Diagnosis typically includes:

• Review of your medical history and symptoms
• Physical exam to check flexibility, nerve function, and muscle strength
• X-rays to confirm vertebral slippage and measure its severity
• MRI or CT scans to assess nerve compression or disc damage

How Is Spondylolisthesis Treated?

Treatment depends on the severity of the slip and your symptoms. Many patients improve with nonsurgical care.

Nonsurgical Treatments

• Rest and avoiding activities that aggravate pain
• Nonsteroidal anti-inflammatory medications (NSAIDs)
• Physical therapy to strengthen core and back muscles
• Bracing to stabilize the spine in younger patients
• Epidural steroid injections to relieve inflammation and nerve pain
• Posture and activity modifications to reduce strain on the spine

Surgical Treatments

Surgery may be considered if:

• Pain or nerve symptoms persist after months of nonsurgical care
• The vertebra continues to slip or cause severe instability
• Nerve compression leads to leg weakness, numbness, or loss of function

Common surgical procedures include:

• Decompression (laminectomy): Removes bone or tissue pressing on nerves, often combined with fusion. Decompression without fusion works best when the instability is minimal
• Decompression and spinal fusion: Relieves the pressure from the nerves and stabilizes the slipped vertebra by fusing it with the one below

What Are the Risks of Spondylolisthesis Surgery?

While generally safe, risks may include:

• Infection
• Nerve injury (rare)
• Failure of bones to fuse properly (nonunion)
• Spinal fluid leak
• Spinal instability or degeneration above or below the fused level
• Persistent pain or stiffness
• Working with an experienced spine surgeon and following your rehabilitation plan reduces these risks.

What Does Recovery Involve?

Recovery typically includes:

• Short-term rest followed by a gradual return to movement
• Physical therapy to restore flexibility and strengthen supporting muscles
• Avoid bending, twisting, or heavy lifting until cleared by your doctor
• Use of a back brace in some cases during healing

How Long Does Recovery Take?

Recovery time after surgery for spondylolisthesis can vary depending on the type of procedure, the number of spinal levels involved, your overall health, and whether a fusion is performed.

• Minor decompression procedures: 4 to 8 weeks for most daily activities
• Spinal fusion: 3 to 6 months for healing and up to 12 months for full recovery

Returning to sports or physically demanding jobs may take longer, depending on healing and stability.

What Is the Outlook for Spondylolisthesis?

With the right treatment, most patients with spondylolisthesis manage their symptoms well and lead active lives. Conservative care helps many avoid surgery, while surgical treatment—when necessary—has excellent outcomes for pain relief, stability, and long-term mobility.