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Spondylolisthesis

Spondylolisthesis is a condition in which a bone (vertebra) in the spine moves forward out of the proper position onto the bone below it.

Causes

In children, spondylolisthesis usually occurs between the fifth bone in the lower back (lumbar vertebra) and the first bone in the sacrum (pelvis) area. It is often due to a birth defect in that area of the spine or sudden injury (acute trauma).

In adults, the most common cause is abnormal wear on the cartilage and bones, such as arthritis .

Bone disease and fractures can also cause spondylolisthesis. Certain sport activities, such as gymnastics, weight lifting, and football, put a great deal of stress on the bones in the lower back. They also require that the athlete constantly overstretch (hyperextend) the spine. This can lead to a stress fracture on one or both sides of the vertebra. A stress fracture can cause a spinal bone to become weak and shift out of place.

Symptoms

Spondylolisthesis may vary from mild to severe. A person with spondylolisthesis may have no symptoms.

The condition can lead to increased lordosis (also called swayback). In later stages, it may result in kyphosis (roundback) as the upper spine falls off the lower spine.

Symptoms may include any of the following:

  • Lower back pain
  • Muscle tightness (tight hamstring muscle)
  • Pain, numbness, or tingling in the thighs and buttocks
  • Stiffness
  • Tenderness in the area of the vertebra that is out of place
  • Weakness in the legs

Signs and Tests

Your doctor will examine you and feel your spine. You will be asked to raise your leg straight out in front of you. This may be uncomfortable or painful.

X-ray of the spine can show if a bone in the spine is out of place or broken.

Treatment

Treatment depends on how severely the vertebra has shifted out of place. Most persons get better with exercises to stretch and strengthen lower back muscles.

If the shift is not severe, you can play most sports if there is no pain. Most of the time, you can slowly resume activities.

You may be asked to avoid contact sports or to change activities to protect your back from being overextended.

You will have follow-up x-rays to make sure the problem is not getting worse.

Your health care provider may also recommend:

  • A back brace to limit spine movement
  • Pain medicine (taken by mouth or injected into the back)
  • Physical therapy

Surgery may be needed to fuse the shifted vertebrae if you have:

  • Severe pain that does not get better with treatment
  • A severe shift of a spine bone
  • Weakness of muscles in one or both of your legs

There is a chance of nerve injury with such surgery. However, the results can be very successful.

Outlook (Prognosis)

Exercises and changes in activity are helpful for most people with mild spondylolisthesis.

Possible Complications

If too much movement occurs, the bones may begin to press on nerves. Surgery may be necessary to correct the condition.

Other complications may include:

  • Chronic back pain
  • Infection
  • Temporary or permanent damage of spinal nerve roots, which may cause sensation changes, weakness, or paralysis of the legs

When to Contact a Medical Professional

Call your health care provider if:

  • The back appears to curve a lot
  • You have back pain or stiffness that does not go away
  • You have pain in the thighs and buttocks that does not go away
  • You have numbness and weakness in legs

References

Earle JE, Siddiqui IJ, Rainville J, Keel JC. Lumbar spondylolysis and spondylolisthesis. In: Frontera WR, Silver JK, Rizzo TD Jr, eds. Essentials of Physical Medicine and Rehabilitation. 3rd ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 49.

Spiegel DA, Dormans JP. Spondylolysis and spondylolisthesis. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 671.6.

Updated: 9/8/2014

C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.


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