Spondylolisthesis

Spondylolisthesis is a spinal condition in which one of the vertebrae (bones of the spine) slips out of alignment. Often, it moves partially in front of the vertebra below it.

This condition can occur from an injury, like playing sports, or from a degenerative condition. It is usually associated with intense pain in the lower back bones.

Looking for Spondylolisthesis Care?

On this page

• What Is Spondylolisthesis?
• What Are the Symptoms of Spondylolisthesis?
• How Do You Diagnose Spondylolisthesis?
• How Do You Treat Spondylolisthesis?

What Is Spondylolisthesis?

Spondylolisthesis occurs when one or more vertebrae (spinal bones) fall out of alignment. This misalignment puts pressure on the vertebrae below.

The term "listhesis" means to slip. The term "anterolisthesis" means to slip forward. If a vertebra has slipped backward compared to the adjacent vertebrae, it is "retrolisthesis."

This instability of the vertebrae can create pain and lead to more spine issues like bone spurs. The cause of spondylolisthesis is usually a degenerative disease, such as arthritis. 

Other causes include:

• Bone diseases, which can weaken bones.
• Congenital (inborn) spine disorders, which can affect spine structure.
• Stress fractures, which often occur during sports, put stress on the back or overstretch the spine.
• Trauma, which can damage the spine, causing the vertebrae to slip.

Treatments typically begin with conservative methods. These include medicines and physical therapy to stabilize and strengthen the spine and abdominal wall.

Most patients experience pain relief within a month or two with this treatment approach. However, if the vertebrae continue to slip or if the pain continues after conservative treatment, your doctor may recommend surgery.

If left untreated, lumbar spondylolisthesis can cause permanent nerve damage and severely impact daily life. It is important to talk with your doctor if you are experiencing symptoms for a month or longer.

What are the types of spondylolistheses? 

Doctors classify spondylolisthesis based on how much the vertebrae have slipped.

The classifications are:

• Grade I — 1% to 25% slippage.
• Grade II — 25% to 50% slippage.
• Grade III — 51% to 75% slippage.
• Grade IV — 76% to 100% slippage.

There are also three types of spondylolistheses:

Congenital spondylolisthesis

Also called dysplastic spondylolisthesis, congenital spondylolisthesis is a spinal condition a person was born with. This congenital disability most often occurs in the L5 to S1 lumbar spine region near the sacrum (tailbone).

Congenital spondylolisthesis symptoms can include pain, tingling, numbness, or weakness. These symptoms often occur along the lower back area, sometimes radiating to the surrounding areas.

Degenerative spondylolisthesis

People with degenerative spondylolisthesis are most often older adults with arthritis. They may experience lower back pain and weakness or pain in the legs.

In this case, the slipped vertebrae pinch nerves in the spine. They may also experience worsening pain when standing or walking for extended periods.

Isthmic spondylolisthesis

Isthmic spondylolisthesis occurs in the joint between two vertebrae. People with isthmic spondylolisthesis tend to have activity-related low back pain or leg pain. 

It usually develops in people with multiple traumas to the spine. It can also occur in athletes whose sports expose them to hyperextended motions, including football and gymnastics.

What causes spondylolisthesis? 

Spondylolisthesis can occur for many reasons. Most commonly, it is the result of chronic or acute trauma to the spine as a teen.

However, any condition that weakens the spine's muscles, bones, and joints can cause spondylolisthesis. 

A fracture or crack of a vertebra can also cause spondylolisthesis. Teens involved in certain sports have a higher chance of occurrence.

These include:

• Gymnastics
• Dance
• Rugby
• Football
• Martial arts
• Soccer
• Basketball
• Weightlifting

Almost 90% of spondylolisthesis cases occur at the L5 vertebrae. 

Spondylolisthesis risk factors

Some people experience spondylolisthesis from birth or as teens. But generally, adults are at higher risk of developing this spine condition. 

Risk also increases if:

• You are older, and your bones and joints have weakened.
• You have a crack or fracture of a vertebra.
• You have a parent with the condition.
• You have chronic or acute trauma to the spinal area.

How can I prevent spondylolisthesis?

There is no way to prevent spondylolisthesis. You can take some steps to reduce the symptoms.

These include:

• Avoiding the movement and exercises that worsen the symptoms. This might include bending, lifting heavy objects, or participating in certain sports.
• Taking over-the-counter or prescription medicine to reduce inflammation.

How common is spondylolisthesis? 

Approximately 4% to 6% of the population in the U.S. has spondylolisthesis or a related condition, spondylolysis, which is when stress fractures form in the thin bone segments between two vertebrae.

Back to top

What Are the Signs and Symptoms of Spondylolisthesis?

While only 10% of people with spondylolisthesis have physical symptoms, they can quickly become debilitating and require treatment or surgery for those who do. 

Spondylolisthesis symptoms include:

• Changes in posture or how you walk.
• Low back pain that worsens or flares up when standing or walking for extended periods and gets better when sitting down or bending over.
• Narrowed spinal canal.
• Pain that spreads into the top or bottom of the thighs.
• Sciatica — which causes pain, numbness, and tingling down the leg. 
• Stiffness in the back.
• Tight hamstring muscles or muscle spasms in the hamstrings.

The pain of spondylolisthesis can range from mild and manageable to severe and disruptive. People describe lumbar spondylolisthesis as a dull, achy pain. It mainly occurs in the lower back, hips, buttocks, and thighs.

For some people, sitting for extended periods can also cause pain. Spondylolisthesis can also produce increased lordosis (swayback) or kyphosis (round back) of the spine. These conditions may or may not result in the need for a back brace or surgery.

When should I see a doctor about my spondylolisthesis symptoms?

You should talk with your doctor if the above symptoms impact your daily life.

Back to top

How Do You Diagnose Spondylolisthesis?  

The doctor will review your medical history and perform a physical exam to diagnose spondylolisthesis. They may ask you to bend forward and feel the curve of your spine. They may also push on different areas and have you do several movements to see when the pain increases and how your spine moves. 

Your doctor may order several diagnostic imaging tests to show if a vertebra is out of place and if any fractures have occurred. 

They may order:

• CT scan – Creates detailed cross-section imaging of the spine using x-rays and computers. A CT scan is better than an MRI for the details of bones but does not show as much about the nerves. 
• MRI scan – Shows the spine's muscles, nerves, disks, and bones. These images can help show the slippage and other issues, like a pinched nerve.
• X-ray – Shows whether a lumbar vertebra has slipped. It can also show degenerative changes like bone spurs or shortened disk height. The x-ray technician may ask you to bend forward or backward for the image. That is so they can find the issue while the spine is in different positions.

Back to top

How Do You Treat Spondylolisthesis? 

Treatment for spondylolisthesis varies depending on how severe the symptoms are and the type of condition. 

Nonsurgical treatment

• Physical therapy – PT is the most common treatment to try first. Many patients who do PT see their pain decrease over time. These exercises help with spine stabilization, strengthening, and stretching.
• Over-the-counter pain medicine — Nonsteroidal anti-inflammatory drugs can alleviate pain and reduce inflammation. 
• Epidural steroid injections — Provide relief from pain if over-the-counter medicines do not work.

Surgical treatment for spondylolisthesis

If your symptoms are not relieved by these treatments, surgery might be an option.

There are two types of surgeries to treat spondylolisthesis:

• Decompression laminectomy – This procedure removes bony spurs in the spinal canal. It frees up space for the nerves and spinal cord. 
• Spinal fusion – Two vertebrae are fused using metal rods, screws, and a bone graft. It provides stronger support for the spine. Surgeons will almost always do spinal fusion after decompression laminectomy.

Back to top

By UPMC Editorial Staff. Last reviewed on 2025-05-16.