What is Spondylolisthesis?

Spondylolisthesis refers to a condition in which one vertebra slips forward relative to the one below it.

This slippage can alter the normal alignment of the spine and may lead to nerve compression, instability, or mechanical back pain.

 

Types of Spondylolisthesis

There are several types, with the most common including:

• Degenerative spondylolisthesis:
  Occurs over time due to aging and wear of the discs and facet joints, leading to gradual instability
• Isthmic spondylolisthesis:
  Caused by a defect or stress fracture in a portion of the vertebra (pars interarticularis), often developing earlier in life
• Congenital or other less common types:
  Related to developmental or structural abnormalities

Each type has different implications for treatment.

 

What Does it Look Like on Imaging?

Spondylolisthesis is typically identified on X-rays, CT scans, or MRI.

Radiographically, it appears as:

• Forward slippage of one vertebra over another
• Changes in spinal alignment
• Associated findings such as disc degeneration or facet joint changes

We often obtain flexion and extension X-rays to evaluate for dynamic instability, meaning whether the degree of slippage changes with movement.

 

Symptoms

Symptoms can vary depending on the degree of slippage and nerve involvement.

They may include:

• Lower back or neck pain
• Radiating leg or arm pain (nerve compression)
• Numbness or tingling
• Muscle weakness
• Difficulty standing or walking for prolonged periods

Some patients may have imaging findings without significant symptoms.

 

Treatment Options

Conservative Management

Initial treatment is typically non-surgical, especially if symptoms are mild to moderate.

This may include:

• Physical therapy to strengthen and stabilize the spine
• Activity modification
• Pain management procedures, including injections

Many patients improve with these measures.

 

Surgical Treatment

Surgery may be considered if:

• Symptoms are persistent or severe
• There is progressive neurological deficit
• There is significant instability or structural compromise

Treatment depends on the patient’s symptoms and imaging findings:

• Decompression:
  Relieving pressure on nerves when nerve compression is the primary issue
• Decompression with Fusion:
  In many cases of spondylolisthesis—especially when instability is present—fusion is recommended to stabilize the spine and prevent further slippage

 

Our Approach

We take a personalized and stepwise approach to spondylolisthesis.

Evaluation includes careful assessment of:

• Symptoms
• Imaging findings
• Presence of instability (often with flexion/extension X-rays)

We begin with conservative management whenever appropriate. When surgery is indicated, we tailor the approach to the individual patient—whether that involves decompression alone or stabilization with fusion—while utilizing minimally invasive techniques whenever possible.

View the approach