Spondylolisthesis (Slipped Vertebra)

How spondylolisthesis happens

The vertebrae are stacked with discs between them and linked at the back by small facet joints and a bony bridge called the pars interarticularis. When the pars is broken or the facet joints and disc wear down, the vertebra can slide forward.

Types

Grades (Meyerding)

Most adults have grade I or II. Higher grades are more common in young people with dysplastic or isthmic types.

Symptoms

• low back pain, often worse with standing, walking or arching backward, and better with sitting or bending forward
• stiffness
• tight hamstrings, with a stiff-legged walk in young people
• sciatica: pain, tingling or numbness spreading into the buttock and leg (see sciatica)
• neurogenic claudication: leg heaviness, pain or weakness when walking that eases with sitting or leaning forward, caused by spinal stenosis
• a visible step in the lower back in high-grade slips

Many people with spondylolisthesis have no symptoms and find out from an X-ray done for another reason.

Diagnosis

• examination: posture, flexibility, hamstring tightness, nerve function
• standing X-rays: show and grade the slip; flexion-extension views show instability
• MRI: shows nerve compression and disc health
• CT or bone scan: detects pars stress fractures in young athletes

Treatment

Non-surgical (most people)

• activity modification: a break from sports or activities that arch the back; young athletes often need several weeks to months off
• physical therapy: core stabilization, hamstring stretching, flexion-based exercises
• pain relief: NSAIDs or acetaminophen (paracetamol), following the label dose
• bracing: sometimes for adolescents with acute spondylolysis
• epidural steroid injections for leg pain from nerve compression
• weight management and general fitness

Surgery

Considered for:

• persistent, disabling pain or leg symptoms despite 3 to 6 months of non-surgical care
• progressive nerve weakness, or cauda equina syndrome
• high-grade or progressing slips, especially in young people

Common operations include decompression (removing bone and ligament pressing on nerves) and spinal fusion with or without instrumentation to stabilize the segment. Pars repair is an option for some young people without significant slip.

Outlook

Most people with low-grade spondylolisthesis manage well with exercise and activity modification. Slippage rarely progresses significantly in adults. Young athletes often return to sport after treatment. Surgery, when needed, usually relieves leg symptoms effectively.

Frequently asked questions

What is spondylolisthesis?

Spondylolisthesis is when a vertebra slips forward over the one below it, most often in the lower back. It can result from a stress fracture in young athletes or from arthritis of the spine in older adults.

What are the symptoms of spondylolisthesis?

Common symptoms are low back pain, stiffness and tight hamstrings. If nerves are pinched, pain, tingling or numbness spread into the buttocks and legs, and walking may cause leg heaviness that eases with sitting. Many people have no symptoms.

Can spondylolisthesis be treated without surgery?

Yes, most cases improve with physical therapy, core strengthening, stretching, activity changes and pain relief. Injections can help leg pain. Surgery is reserved for severe, persistent or worsening symptoms or high-grade slips.

Can spondylolisthesis get worse?

It can progress, particularly in children and teens during growth spurts and in high-grade slips. In adults with degenerative spondylolisthesis, significant progression is uncommon. Regular follow-up X-rays may be advised for young people.