Spondylolisthesis

What is spondylolisthesis?

Spondylolisthesis happens when one of the bones of your spine - a vertebra - slips forward out of line with the bone below it. It is most common in the lower back (lumbar spine). Sometimes called a slipped vertebra, it is not the same as a slipped disc, though the two can occur together. How far the vertebra has moved is described using grades from I to V, from a minor slip through to a severe one.

There are two common types. Isthmic spondylolisthesis usually follows a small stress fracture in the vertebra (a spondylolysis) and is often seen in younger, active people whose sport involves repeated arching of the back. Degenerative spondylolisthesis develops later in life as the facet joints and discs wear, allowing the vertebra to drift forward, and is more common with age.

The reassuring part: most low-grade spondylolisthesis is managed without surgery. Our role is to confirm the grade and whether any nerve is involved, then guide you toward the least invasive treatment that gives a durable result.

Symptoms to look for

Many people have a mild slip with few or no symptoms. When symptoms do appear, they often include:

• Lower back pain and stiffness, typically worse with activity and standing, and easier with rest.
• Tight or aching hamstrings, which can change the way you stand or walk.
• Leg pain, numbness, or tingling (sciatica) if the slip narrows the space around a nerve.
• Leg heaviness or cramping when walking or standing for a while, easing when you sit or lean forward.
• Muscle weakness in a leg or foot in more significant cases.

What causes spondylolisthesis?

The cause depends on the type. Isthmic slips follow a stress fracture in part of the vertebra, usually from repeated bending, arching, and twisting - which is why they are linked to sports such as gymnastics, weightlifting, and football, often in genetically susceptible teenagers. Degenerative slips are driven by age-related wear of the facet joints and discs, which lets one vertebra drift forward on another.

Risk factors include a family history of the condition, being an adolescent involved in high-impact or hyperextension sport, and the general wear that comes with aging. Degenerative spondylolisthesis becomes more common after 50 and is seen more often in women.

How we diagnose it

Diagnosis begins with your history and a focused physical and neurological examination to check your movement, reflexes, and nerve function. A standing X-ray shows the slip and its grade, and flexion-extension views can reveal whether the segment is unstable. An MRI shows the discs and nerves, which is important if you have leg symptoms.

Just as important, we match the imaging to your symptoms. A slip seen on a scan does not always explain a person’s pain, so we treat the person - not the picture. Your assessment is led by a US board-certified neurosurgeon.

Treatment - least invasive first

We follow a measured, surgery-last approach. For most people, especially with a low-grade slip, that means starting with non-surgical care and escalating only if the evidence calls for it.

• Non-surgical care (first line for most). Activity modification, physiotherapy, and core and hamstring strengthening help support the spine, alongside anti-inflammatory medication for symptom relief. Periodic monitoring can check that the slip stays stable.
• Targeted injections. If leg pain from an irritated nerve persists, an image-guided epidural steroid injection can calm inflammation and support recovery without surgery.
• Surgery (when warranted). For a high-grade or progressing slip, or nerve compression that has not responded to conservative care, surgery may be discussed. Decompression relieves pressure on the affected nerves, and where the segment is unstable this is often combined with a minimally invasive fusion (MIS fusion) to stabilize it. More extensive surgery is reserved for cases that genuinely need it.

If you have already been told you need surgery, we are glad to give an honest second opinion on whether a less invasive path could work for you.

What to expect

With non-surgical care, expect gradual improvement over weeks to months as strength and support around the spine build up. If you do need surgery, recovery varies with the procedure - a decompression alone is often quicker, while a fusion can take several months up to around a year to heal fully. Your surgeon will explain the timeline and any precautions for your specific case, and the plan is built around you, with clear explanations at every step.