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Spondylolisthesis—Definition, Symptoms, and Treatments

Spondylolisthesis

Watch how spondylolisthesis can cause nerve compression or irritation.

Spondylolisthesis Definition

Spondylolisthesis is a forward slippage of a vertebra in the spine. The two parts of the term “spondylolisthesis” derive from Greek:

 

spondyl = vertebrae

olisthesis = slip

 

Degenerative spondylolisthesis affects older people and primarily occurs at the L4 and L5 vertebrae.1

Spondylolisthesis Symptoms

Symptoms of spondylolisthesis include the following:

  • Low back pain
  • Leg pain
  • Heaviness
  • Fatigue
  • Tight hamstring muscles

If enough slippage occurs, the vertebrae can narrow and press on nerves in the spine, resulting in pain. This narrowing can be associated with symptoms of lumbar spinal stenosis.4 Your doctor may also refer to the symptoms of lumbar spinal stenosis as neurogenic intermittent claudication. When lumbar spinal stenosis develops, relief from symptoms is found through leaning forward or sitting (flexing the spine).

 

Learn more about lumbar spinal stenosis

Higher Spondylolisthesis Occurrence in Women

Women are up to six times more likely than men to be affected by spondylolisthesis. The incidence among black women is even higher than among white women. This higher incidence is believed to be due in part to the effects of female hormones on ligaments in the spine.3,4,5

Varying Degrees of Slippage

The severity of slippage is categorized by doctors on a scale of grade 1 (least advanced) to grade 5 (most advanced). In a majority of patients, the amount of slippage rarely exceeds 30% of the width of the vertebra.2

Spondylolisthesis Grade 1

25% of vertebral body has slipped forward

Spondylolisthesis Grade 2

50% slippage

Spondylolisthesis Grade 3

75% slippage

Spondylolisthesis Grade 4

100% slippage

Spondylolisthesis Grade 5

Spondyloptosis: when the vertebra has completely fallen off

Spondylolisthesis Causes

In most cases, degenerative spondylolisthesis begins with disc degeneration, leading to structural instability and arthritic facet joints.3

 

Additional causes can include the following:

  • Injury to the back
  • Job related stresses on the spine due to the heavy lifting
  • Strain due to sports such as football, weightlifting, and gymnastics

Spondylolisthesis Treatment

Many people with degenerative spondylolisthesis have a stable condition that doesn't progress.3,2 But, once symptoms interfere with daily activities, it’s important to begin a treatment regimen and avoid all activities that can worsen the condition—for example, heavy lifting.

Nonsurgical Spondylolisthesis Treatment Options

More conservative treatment for spondylolisthesis includes bed rest (generally advised only after an injury), physical therapy, medications, or wearing a corset or brace.

 

If these treatments aren’t effective, and your symptoms interfere with daily activities, your doctor may recommend spinal surgery.

 

A study recently compared nonsurgical and surgical treatment in people with persistent pain from spondylolisthesis. Patients who had undergone surgery showed significant improvements in pain and the ability to function when compared with those not treated with surgery.5

Interspinous Spacer Implant

For people with stable, grade 1 spondylolisthesis or less, an interspinous spacer can be implanted during a minimally invasive surgical procedure to lift the vertebra off the pinched nerve, which may provide sustained relief from symptoms.

 

Learn more about the interspinous spacer

Traditional Spondylolisthesis Surgery

For people with spinal instability or greater than grade 1 spondylolisthesis, traditional surgical methods are sometimes recommended to create more space around the nerves and relieve pressure. Unlike the procedure to implant an interspinous spacer, these surgeries involve a decompressive laminectomy and spinal fusion.

Decompressive Laminectomy (Open Decompression)

A laminectomy involves removal of structurally important vertebral bone and ligaments to create more space in the spinal canal and decompress the pinched nerves. Once this procedure is completed, it is commonly followed by spinal fusion.

 

Learn more about decompression surgeries

Spinal Fusion

Fusion surgery involves "re-aligning" the spine by fusing the vertebrae at the site of the slippage. The fusion creates a solid bridge of bone along the vertebrae. Rods or screws may also be needed to hold the bones in place.

 

Learn more about spinal fusion

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References:

  1. Cauchoix J, Benoist M, Chassaing V: Degenerative spondylolisthesis. Clin Orthop 115:122–129, 1976.
  2. Matsunaga S, Sakou T, Morizono Y, et al: Natural history of degenerative spondylolisthesis. Pathogenesis and natural course of the slippage. Spine 15:1204–1210, 1990.
  3. Bassewitz, H. and H. Herkowitz, Lumbar stenosis with spondylolisthesis: current concepts of surgical treatment. Clin Orthop, 2001(384): p. 54-60.
  4. Jacobsen S, Sonne-Holm S, Rovsing H, Monrad H, Gebuhr P. Degenerative lumbar Spondylolisthesis: an epidemiological perspective: the Copenhagen Osteoarthritis Study. Spine 2007;32:120-5.
  5. Weinstein JN, Tosteson TD, Lurie JD, et al, for the SPORT Investigators. Surgical versus nonsurgical therapy for lumbar spinal stenosis. NEJM. 2008;358:794-810.