Understanding spondylolisthesis causes, symptoms and treatment

By Michael Perry, M.D.


Spondylolisthesis is a degenerative spine condition that can cause severe pain and stiffness in the neck or back, making simple tasks like walking or household chores very difficult. If you have been experiencing pain and difficulty standing or walking for an extended amount of time, or if bending to tie your shoes or pick up something off the floor is becoming increasingly impossible, you should schedule an appointment with your doctor to determine if spondylolisthesis is to blame for your pain. If left untreated, this condition could continue to worsen and may lead to a significant decline in your quality of life.

Description of spondylolisthesis causes

“Spondylolisthesis” is a term used to describe vertebral slippage. A spondylolisthesis diagnosis is characterized by the displacement of one vertebra over another, and slippage can occur in any direction. Spondylolisthesis is found most frequently within the lumbar (lower) region of the spine. This is due to the fact that this area is exposed to a great deal of pressure caused by the movements associated with lifting heavy objects and twisting the torso.

The lumbar region also bears most of the weight of the upper body. Gymnasts, weightlifters, football players, hockey players and other athletes are especially susceptible to spondylolisthesis because of the tremendous amount of stress they place on their lower backs. But, even though the condition is seen frequently in athletes, spondylolisthesis can also be inherited or present at birth (a congenital condition), an effect of aging or a result of an injury or trauma to the spine.

Spondylolisthesis symptoms and diagnosis

If you have spondylolisthesis, you may experience symptoms such as tightness or stiffness in the back muscles, pain in the thighs and buttocks and pain in the area of the spine where the slippage occurred. Grades are used to classify the condition, with a grade 1 spondylolisthesis diagnosis signifying the least amount of slippage and a grade 5 representing 100 percent slippage. The less slippage there is, the less likely that the associated symptoms will become debilitating. However, even a minor displacement of a vertebra can cause nerve compression and chronic pain.

Symptoms might be experienced at the actual site of the spondylolisthesis or they can develop in an apparently unrelated area of the body. Pain and stiffness are most common at the site of the vertebral slippage, but if a displaced vertebra makes contact with (compresses) a nearby nerve root, a set of neurological symptoms known as radiculopathy could be produced. Radiculopathy is characterized by radiating pain, tingling, numbness and weakness or loss of function in the group of muscles that are innervated by the compressed nerve root. The areas affected by nerve compression symptoms will depend on the location of the vertebral slippage. Vertebral displacement in the lower back could lead to symptoms that are felt in the buttocks, legs, feet and toes, while spondylolisthesis in the cervical (upper) region can affect the shoulders, arms, hands and fingers. Regardless of its location, the condition can also lead to spinal cord compression, which could result in myelopathy, which is characterized by severe loss of muscular function or even paralysis in the lower body.

To reach a diagnosis of spondylolisthesis, a physician may use an imaging scan to confirm the presence of vertebral slippage. The slippage will then be assigned a grade of 1 to 5, which will help determine the type of treatment necessary.

Spondylolisthesis treatment

Treatment prescribed for spondylolisthesis varies. To recommend a treatment plan, your physician will assess the severity of your condition and the symptoms it is causing, as well as your overall health and medical history. Most likely, your physician will first recommend a variety of conservative treatments, such as:

  • Medications. Anti-inflammatory drugs and pain medications can both be very helpful in the management of spondylolisthesis symptoms. Patients have several over-the-counter options, such as ibuprofen and acetaminophen, or they may request a stronger prescription if OTC medications are not effective.
  • Epidural spinal injections. In addition to oral medications, injected medications can also help minimize pain and inflammation caused by spondylolisthesis. Injections can be given individually or as a series, although there is typically a limit on the number of these treatments a patient can receive over the span of a year. Nerve block injections can also be administered to temporarily desensitize the nerves that are transmitting the pain signals.
  • Physical therapy. Targeted exercises can be highly beneficial for patients with spondylolisthesis. A professional physical therapist can recommend a series of strengthening exercises, isometric and isotonic exercises, muscle stretches and balance-enhancing techniques to minimize back pain and other spondylolisthesis symptoms while helping you build up muscle mass and increase flexibility in the body.
  • Low-impact exercise. Walking, swimming and similar gentle exercises can help improve circulation and expand your range of motion. However, you should be careful to avoid harsh motions or movements that impact the spine (such as running or contact sports), which can make spondylolisthesis symptoms worse.
  • Alternative care. Although the following options are less traditional than medications and exercise, therapies such as acupuncture, yoga and chiropractic adjustments can be helpful in the management of spondylolisthesis pain.

Most patients are instructed to use these therapies for several months, testing various combinations of conservative treatments to find an effective routine. This can take a bit of trial and error, although you should be able to develop a spondylolisthesis management plan with the assistance of your physician. If, however, conservative treatments do not produce the desired results, your doctor may eventually recommend surgery to help you obtain more meaningful symptom relief.

Surgery for spondylolisthesis

If surgery becomes a consideration, you may have several options to explore. For instance, traditional open back surgery may be a treatment option for nerve compression, although minimally invasive spine surgery may offer more benefits, such as shorter recovery times and lower complication rates.^

At Laser Spine Institute, we offer several minimally invasive decompression spine surgeries that may be effective for patients with spondylolisthesis and other degenerative spine conditions. For instance, a patient may consider the following surgeries to treat nerve compression in the spine:

  • Foraminotomy. During this procedure, a surgeon removes bone matter and tissues that are compressing a nerve in the spinal canal.
  • Laminotomy. During this procedure, a surgeon removes part of the lamina (the arch that goes over the top of the spinal canal) to help relieve spinal cord compression.
  • Discectomy. During this procedure, a surgeon removes herniated or bulging disc material that is pressing on the spinal cord or nerve root. This procedure is often combined with a stabilization surgery, which replaces a damaged disc with a bone graft, to treat spondylolisthesis.
  • Facet thermal ablation. During this procedure, a surgeon deadens a nerve ending and cleans a facet joint to reduce pain and other symptoms.

Laser Spine Institute also performs minimally invasive stabilization procedures which can be an alternative for patients who have been recommended for a traditional open spine fusion procedure. Our spondylolisthesis surgeries are performed on an outpatient basis, which enables patients to leave our facility the same day as their surgery and recover from the procedures in the comfort of their own homes or hotel rooms.

For more information about the minimally invasive surgery we offer, contact us today. We also can review your recent MRI at no cost* to determine if you may be a candidate for one of our minimally invasive spondylolisthesis procedures.