What Is Spondylolisthesis?

Spondylolisthesis is a spine condition caused when one vertebra slips over another. This condition’s symptoms sometimes mimic those of other back pain conditions.

The complex design of the spinal column is a biological wonder. It comprises 33 bones at birth – some eventually fusing to become 24 bones in most adults – 23 discs and more than 40 muscles and ligaments. The spine is genuinely nature’s stage for the human body’s performance. And all those bones, discs, muscles and ligaments must work together perfectly for our bodies to function correctly.

Sometimes, the mighty machinery of the spine breaks down. Many spinal conditions can affect a person throughout their lifetime, from simple back pain to spinal tumors. With so many working pieces, plenty can go wrong when the anatomy of the spine isn’t quite right.

A spinal condition called spondylolisthesis occurs when one vertebra of the spine slips forward over the one beneath it. This vertebra becomes out of alignment with the rest of the spinal column. The condition appears most commonly at the base of the spine in the low back vertebrae, also known as the lumbar spine.

There are three main types of spondylolisthesis:

  • Congenital: appears in the womb, before birth, when a baby’s spine doesn’t properly form. 
  • Degenerative: happens over time, usually with advanced age.  
  • Traumatic: occurs due to direct injury to the spine.

Diagnosis and Symptoms

Spondylolisthesis is graded by diagnosing physicians on a percentage severity scale from 1 and 5, with five being the most severe degree of vertebral slippage. An MRI is typically required to diagnose spondylolisthesis fully and to help rule out other spinal conditions, since its symptoms closely match those experienced by people with other spine issues.

In some people who have spondylolisthesis, especially those with a lower degree of vertebral slippage, the condition may cause no symptoms. However, in those who have a higher vertebral slippage score, or when the slipped vertebra is pressing on a nerve, a variety of symptoms can result, including:

  • Back pain that seems to worsen with activity.
  • Difficulty standing or walking, especially for long periods.
  • Numbness, stiffness or tightness in the muscles of the spine, especially those in the lower back, or tightness in the hamstrings.
  • Pain in the low back or buttocks, which may radiate down the legs, and is known as sciatica pain.

Exercise with Spondylolisthesis

Because certain types of activity can make spondylolisthesis symptoms worse for some people, this diagnosis can lead to inactivity. However, it’s crucial to note that certain types of regular movement can help relieve the symptoms associated with spondylolisthesis. Moving the body regularly helps to strengthen the spine and core muscles, which ultimately create better support for the spine in the long run.

When the symptoms of spondylolisthesis begin to impair mobility or proper body mechanics, that is when people should evaluate activities for safety. For example, heavy weightlifting, backbends or high-intensity sports that involve running or jumping should likely be avoided because they can make spondylolisthesis worse, which could lead to a condition called spinal stenosis.

There are still plenty of alternative activities a person with spondylolisthesis can engage in that may help provide back pain relief from the condition. These activities include gentler core exercises such as planks, yoga and gentle stretching. The key is to modify activities to reduce stress or strain on an already irritated spine.

Physical Therapy and Treatment Options

If you’re unsure of what to do that won’t worsen the condition, physical therapy can be a powerful and effective place to start. Under the trained guidance of a physical therapist, many people with spondylolisthesis develop the proper technique to perform exercises that help alleviate their symptoms and allow them the confidence to continue those activities at home.

From physical therapy to specific medications, most spine experts agree that conservative options are effective best places to start for spondylolisthesis treatment. Surgery is only considered when such alternatives fail to provide adequate relief or are ineffective in helping someone with spondylolisthesis return to active living.

As a complex spinal condition, it’s always recommended to seek care and treatment for spondylolisthesis by a trained and experienced spine specialist.

Neel Anand MD