Spondylolisthesis

What is Spondylolisthesis?

The quick answer is that Spondylolisthesis is a condition in which there is forward slipping of one of the vertebrae (the bones that make up the spine) on to the other. This typically occurs in the lower back and can be increasingly painful if the bone slips so much to pinch on a nerve. It is the most common cause of back pain in teens. 

Watch this video on where lower back pain begins.

How does it occur?

There are Three Main Types of Spondylolisthesis:

  • Congenital Spondylolisthesis: the result of abnormal bone formation that occurs at birth. In these cases, the spine is more susceptible to slippage due to the abnormal formation at birth. 
  • Isthmic Spondylolisthesis: This is due to present spondylosis, which is a condition that results in small stress fractures in the bone. The stress fractures weaken the bone to cause the forward slippage of the vertebrae. 
  • Degenerative Spondylolisthesis: This is due to increasing age. The disks between the vertebras become less spongy, with age, and are less able to resist the sheer forces in the spine, resulting in increased slipping forward on the vertebrae.

Other types of spondylolisthesis occur due to trauma, a disease or condition causing weakening of the bones or post-surgical complications. 

What is spondylolisthesis?Image of Spondylolisthesis

What are the symptoms?

Many people in the population with a spondylolisthesis don’t even know they have one. They experience no complaints of pain. If they do have symptoms, the main complaint is low back pain across the lower spine. They will sometimes characterize it as a muscle strain type of pain. 

Other symptoms may include hamstring muscle cramping, stiffness, pain in the buttocks, and changes in posture. 

Treatment of Spondylolisthesis

Treatment depends on the severity of the slippage, severity of symptoms and age of the patient. 

  • Conservative: 
    • Rest: take time away from activities which usually bother the lower back. Don’t go to complete bed rest, but gentle, light walking and limitations in normal activity is a sufficient amount of rest. 
    • Take a break: take a break from sports and other activities that bother the spine. 
    • NSAID’s: consult your physician about your ability to take over the counter anti-inflammatories to help the pain. At times, epidural steroid medications are used to help with inflammation and pain. 
    • A brace or back support: A brace or back support may be used to help reduce the pain and symptoms. If one of these is used, it should be used in conjunction with physical therapy to decrease the continued weakening of the muscles. 
    • Physical therapy: Physical therapy is focused on strengthening the abdominal and core muscles to protect the spine. A regimen of 8-12 weeks of continuous core stabilization activities are important to assist in decreasing pain and improving return to daily life. Stretching, flexibility and postural education are also integral parts of treatment. 
  • Surgery: May be warranted if the vertebra continue to slip or the pain does not improve. 

What is the probability the pain will return?

By keeping your back and abdominal muscles strong, it will decrease the risk of re-occurrence by supporting and stabilizing your back. Modifying your activity level by choosing activities that reduce the amount of stress on the spine, will help prolong your spine health. Maintaining proper weight and a healthy diet will also decrease the amount of stress on the spine.  


By: Ehren Allen, PT/Certified Manual Therapist

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