Spondylolisthesis

This usually occurs in your lower back but can also occur in your neck or mid to upper back. A slipped vertebra can put pressure on the nerves in your spinal canal, which connect your brain and your body. This can cause pain, pinching, numbness and weakness, usually in your lower back and legs. 

Spondylolisthesis is not the same as a slipped disc — a slipped disc refers to one of the fluid-filled cushions between your vertebrae slipping out of position.

Spondylolisthesis is pronounced spohn-di-low-less-THEE-sis. In Greek, spondylos means spine or vertebra and listhesis means movement, sliding or slipping.

Spondylolysis and spondylolisthesis both cause lower back pain but they are not the same condition. 

Spondylolysis is caused by a bone defect in your spine, which is usually caused by a stress fracture. It is common in young athletes.

Spondylolisthesis is caused by a vertebra slipping out of place and putting pressure on the vertebra below it as well as the nerves that run through the spinal canal. 

However, spondylolysis can cause spondylolisthesis if the stress fracture results in the vertebra slipping.

Spondylolisthesis is most common in your lower back and might cause these symptoms:

• Lower back pain which may get worse during activity
• Pain, numbness or pins and needles down your legs (these symptoms are known as sciatica)
• Tight hamstrings
• Stiff back
• Curvature or bulging of the spine

If you have difficulty walking and feel unsteady on your feet, this may also be a sign.

It's possible to have spondylolisthesis without any of these symptoms.

You should see your GP if: 

• You have persistent back pain or stiffness
• You have persistent pain in your buttocks or thighs
• Your back curves outwards

Your GP may examine your back, although spondylolisthesis doesn’t usually cause any visible symptoms. They may also examine your limbs to see the amount of movement and pain you have. This may include a straight leg test — this involves lying on your back while your GP holds your foot and gently lifts your leg up while you keep your knee straight.

You may need an X-ray while standing to see if you have a slipped vertebra in your spine or a spinal fracture. If you have numbness, weakness or tingling in your legs, you may also need an MRI scan or CT scan to detect if your slipped vertebra is compressing a nerve.

• There are different causes of spondylolisthesis:

  • A birth defect in a vertebra — this can cause the vertebra to slip forward 
  • A sudden injury, such as a fracture from a car accident
  • An infection or tumour that causes a bone abnormality
  • Gradual wear and tear of the vertebrae and cartilage (osteoarthritis) — this is more common in older people
  • Repetitive trauma, such as heavy weight lifting or gymnastics, which causes a defect in your spine to develop
  • Spinal stenosis

  Types of spondylolisthesis

  The three most common types of spondylolisthesis are:

  • Congenital spondylolisthesis — a defect in the formation of a baby's spine before birth that increases the risk of a vertebra slipping in later life
  • Degenerative spondylolisthesis — the most common type of spondylolisthesis caused by thinning of the vertebral discs (fluid-filled cushions that sit between the vertebrae) as you get older; the discs thin because they lose water and thinner discs increase the chance of a vertebra slipping out of place
  • Isthmic spondylolisthesis — caused by spondylolysis ie a defect of the spine usually caused by a stress fracture

  Less common types of spondylolisthesis include:

  • Pathological spondylolisthesis — caused by a disease (eg osteoporosis) or a tumour
  • Post-surgical spondylolisthesis — caused by spinal surgery 
  • Traumatic spondylolisthesis — caused by an injury to the spine

Your risk of developing spondylolisthesis is greater if: 

• You are a young athlete — children and teenagers who play sports that stretch the lower spine eg football or gymnastics; spondylolisthesis usually occurs during a growth spurt and is the most common cause of back pain in teenagers
• You are aged over 50 — degenerative spondylolisthesis is more likely as you get older as it is caused by wear and tear of the spine over time, although it also has a genetic component
• You are born with part of your vertebra called the pars interarticularis being thinner than normal — the pars interarticularis connects the facet joints which link a vertebra to the vertebrae above and below it so your spine can function as a unit; a thinner pars interarticularis is more likely to fracture and cause the vertebra to slip
• You have another degenerative spinal condition

The treatment you receive will depend on the severity of your symptoms and how much they are affecting your quality of life. In most cases, your doctor will recommend non-surgical treatments first, such as: 

• Anti-inflammatory painkillers eg ibuprofen — if over-the-counter medications are not enough to reduce your pain, your doctor may prescribe stronger painkillers
• Bracing — usually only for children
• Steroid injections to relieve inflammation and pain — this includes: 
• Facet joint injections 
• Injections around the nerve that is being compressed by the slipped vertebra
• Physiotherapy — targeted daily exercises to stretch and strengthen your abdomen, hamstrings and lower back; this will help reduce your pain and increase your range of motion
• Rest — avoiding activities, such as bending, lifting, athletics and other sports, for a short period of time

These treatments provide temporary relief and during this time, your symptoms may go away on their own. 

Your doctor will usually only recommend back surgery if:

• A nerve is compressed
• Non-surgical treatments have not worked
• Your symptoms are persistent and severe

The type of back surgery you have will depend on what type of spondylolisthesis you have. This could be: 

• Decompression surgery to remove part of your spine to relieve pressure
• Surgery to fuse the slipped vertebra to the vertebrae next to it using metal rods and screws and a piece of your own bone — this will keep the slipped vertebra in place
• Surgery to remove the vertebral disc between two vertebrae and replace it with a metal cage containing a bone graft — this will hold the vertebrae apart

These are major surgeries and you will need to stay in hospital for up to a week. It will take months for a full recovery.  

Surgery usually relieves many spondylolisthesis symptoms, including pain and numbness in the legs. However, there are risks of complications, including: 

• Damage to the spinal nerves or spinal cord — this can cause ongoing symptoms of numbness or weakness in the legs and in rare cases, bowel incontinence, urinary incontinence or paralysis
• Deep vein thrombosis (DVT) — a blood clot in one of the deep veins in your leg 
• Infection at the surgical site 

Your doctor or surgeon will discuss the details of your surgical options and the risks involved before you make a decision. 

Will spondylolisthesis come back?

In most cases, pain caused by spondylolisthesis goes away after recovering from spondylolisthesis surgery. Over time, you can return to your normal activities and regain full function and movement.

Spondylolisthesis can cause cauda equina syndrome. At the base of your spinal cord is a collection of nerves called the cauda equina. In cauda equina syndrome, these nerves are compressed, which can cause loss of feeling in your legs and bladder problems. It is a medical emergency. If it is not treated it can cause urinary incontinence and paralysis.

• Eat a healthy, balanced diet to maintain strong bones
• Maintain a healthy weight — being overweight or obese puts extra strain on your spine
• Perform regular exercises to strengthen your back and abdomen

In some cases, spondylolisthesis comes back but this is usually if your first instance of spondylolisthesis was severe ie your vertebra moved considerably out of its normal position. 

However, after spondylolisthesis surgery, most people return to normal activities after a recovery period, although your spine will be less flexible.