The spine is made up of a series of interconnecting bones called vertebrae that form the spinal column - the main support structure for the body that keeps it upright and balanced. Other functions of the spine include:

• Providing platforms for attachments of many muscles and ligaments that traverse the skull, the thorax, and the pelvis
• Permitting the trunk of the body to have appreciable flexibility of movement, such as twisting, bending, or arching the back
• Protecting the spinal cord while providing openings between adjacent vertebrae for the passage of spinal nerves.

Spondylolisthesis occurs when one vertebra slips over the vertebra just below it. Though it can occur at the level of cervical vertebrae, it occurs most often at the level of the lumbar vertebrae. Symptoms can range from none at all to severe symptoms with pain and weakness in the legs. Slippage may result in lordosis ("swayback") or kyphosis ("roundback"), a backward curve of the spine at the lower back where L5 (the fifth lumbar vertebra) slips over the sacral promontory. Most cases of spondylolisthesis are not severe and do not involve high levels of slippage. The severity of spondylolisthesis is determined by the degree of slippage observed on X-rays.

Spondylolisthesis can be caused by various conditions, but the symptoms are basically similar and include:

• Lower back pain
• Stiffness in the back
• Localized pain or tenderness in the back just above the pelvis
• Tight hamstrings
• Pain in the thighs and legs (radiculopathy)
• Pain in the buttocks

In general, there are several types of spondylolisthesis based on the underlying cause of the vertebral slippage:

• Dysplastic or congenital - caused by a malformation in the baby's spinal column before birth
• Isthmic - caused by a defect or fracture of the bone that connects the upper and lower facet joints of a vertebra
• Degenerative - caused by degeneration of the facet joint due to aging and normal "wear and tear"
• Traumatic - caused by an injury to the spinal column
• Pathological - caused by an underlying pathological disorder such as cancer or bone disease
• Iatrogenic - caused by a previous surgery to the spine

Most patients with low-grade spondylolisthesis are asymptomatic. The clinical course of the condition is generally benign regardless of age. High-grade spondylolisthesis is thought to occur in 5%-10% of cases of spondylolisthesis. It typically develops during childhood or adolescence and is associated with a high risk of progression. Adults who are diagnosed with high-grade slippage are typically stable and rarely experience further progression of slippage. Slip progression after skeletal maturity is usually related to disk degeneration secondary to osteoarthritis at the slip level. This is likely to develop during the fourth and fifth decades of life with the onset of degenerative spondylolisthesis.

The diagnostic evaluation for spondylolisthesis includes a patient history, a physical examination, and radiological imaging studies. There are numerous reasons that a person may experience back pain and these must be ruled out before the relationship between back pain and spondylolisthesis can be established.

Other causes of back pain may include:

• Lumbosacral strain - strain of the muscles or ligaments of the lower back that typically appears as sudden lower back pain
• Radiculopathy caused by compression or irritation of the nerve roots due to degeneration or herniation of the intervertebral disk
• Intermittent claudication due to either vascular insufficiency (which reduces blood circulation to muscles during walking) or to neurologic causes (e.g., peripheral neuropathy)
• Poor muscle tone and spinal alignment
• Arthritis
• Juvenile osteoporosis
• Osteosarcoma (bone cancer)
• Congenital hypoplasia of the spine - incomplete development of any part of the spine.

The primary goals of treatment for individuals with spondylolisthesis include:

• Relieving pain
• Restoring spinal flexibility and function
• Stopping the progression of slippage

There are two basic categories of treatment options for spondylolisthesis:

• Conservative treatment
• Surgical treatment

Conservative treatments for spondylolisthesis include:

• Lifestyle modifications
• Physical therapy
• Drug therapy

Surgery for spondylolisthesis is recommended if conservative therapy has not been effective, symptoms progress, and unremitting pain leads to a significant disruption in quality of life.

The goals of spondylolisthesis surgery include:

• Relieving pressure or compression of the affected nerves
• Stabilizing the vertebrae with fusion to prevent further slippage and nerve compression
• Restoring spinal alignment and function

Spondylolisthesis can have a significant impact on function and quality of life due to pain and restrictions on activity. This can be especially frustrating for young and active individuals.

Some suggestions that may be helpful in minimizing the risk of further slip progression in both children and adults with spondylolisthesis include:

• Maintaining an ideal weight
• Muscle strengthening exercises
• Education regarding daily living activities such as learning how to bend properly
• Education regarding the condition and its treatment options is very important for providing the individual with a sense of control, as well as important information required to make informed treatment decisions.

Knowledge is Critical when Dealing with a Painful and often Debilitating Condition such as Spondylolisthesis

If you or a loved one has been diagnosed with spondylolisthesis, it's critical to learn everything you possibly can about this condition so that you can make informed decisions about your treatment. That's why we created the Medifocus Guidebook on Spondylolisthesis, a comprehensive 146 page patient Guidebook that contains vital information about spondylolisthesis that you won't find anywhere in a single source.

The Medifocus Guidebook on Spondylolisthesis starts out with a detailed overview of the condition and quickly imparts fundamentally important information about spondylolisthesis, including:

• The underlying causes of spondylolisthesis.
• The **risk factors that can increase a person's chances for developing spondylolisthesis

• A detailed overview of the different types of spondylolisthesis that are recognized and, which, serve as a basis for classifying patients into the following groups:

  • Isthimic spondylolisthesis
  • Dysplastic (congenital) spondylolisthesis
  • Degenerative spondylolisthesis
  • Traumatic spondylolisthesis
  • Pathologic spondylolisthesis
  • Postoperative (iatrogenic) spondylolisthesis

• The relationship between a condition known as spondylolysis and the development of isthmic spondylolisthesis - the most common type of spondylolisthesis observed.

• A description of the Meyerding grading system that is used by doctors to determine the degree (severity) of slippage in people with spondylolisthesis. Using this grading system, patients may be classified into either low-grade or high-grade slippage groups, which serves as an important basis for planning an appropriate course of treatment.
• How spondylolisthesis is diagnosed based on factors such as signs/symptoms, patient history, physical examination, neurological evaluation, and radiological (imaging) studies.

Understanding the Standard Treatments...and the Treatment Options

The primary goals of treatment for individuals with spondylolisthesis include:

• Relieving back pain and radiculopathy (pain radiating to the legs)
• Restoring spinal flexibility and improving range of motion
• Stopping the progression of slippage

Understanding the standard treatments - and the treatment options - is critical for achieving the goals of treatment and, thereby, maintaining the patient's overall functional capacity and quality of life. As you read through the section of the Guidebook that focuses on the treatments for spondylolisthesis, you will specifically learn about:

• The conservative treatments that are often the first-line approach for the management of people with spondylolisthesis, which include:

  • Lifestyle modifications
  • Physical therapy
  • Orthotic devices, such as corsets and braces

• The medications that are often prescribed to alleviate back pain in patients with spondylolisthesis.

• The surgical treatment options that are available for patients who have failed to achieve adequate relief with conservative treatments and who continue to experience unremitting pain that leads to a significantly reduced quality of life. These surgical treatment options, which are reviewed in detail in the Guidebook, include:

  • Direct repair of the pars interarticularis
  • Posterior fusion without instrumentation
  • Posterolateral fusion with instrumentation
  • Interbody fusion
  • Laminectomy

• The risks, benefits, and complications that are associated with the various surgical techniques for spondylolisthesis.

• The prognosis (outlook) for people with spondylolisthesis including the important factors that can have a significant impact in predicting the overall chances of recovery.
• The impact of spondylolisthesis on the patient's quality of life, including practical tips and suggestions for how to minimize the impact on your lifestyle and better cope with the condition.
• Important questions to ask your doctor about spondylolisthesis.

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Updated: January 26, 2023
146 Pages