Spondylolisthesis is a condition where one of the vertebrae in the spine slips forward on the bone below it. Normally, vertebrae align on top of one another, and the discs, facet joints, and ligaments maintain their position. Spondylolisthesis is caused by weakening joints and ligaments that hold the spine in the correct place.
Spondylolisthesis is the most common cause of back pain during the teenage years, and symptoms often occur during adolescent growth spurts. Degenerative spondylolisthesis occurs mainly after 40 years of age.
It is possible to have spondylolisthesis and experience no symptoms at all. However, the most common symptom is lower back pain. It is often described as a tightness or stiffness that spreads across the lower back, similar to a muscle strain. Muscle spasms in the back of the thighs (hamstrings) can occur, causing issues with movement and posture.
If the slipped vertebra is pressing on a nerve, patients may experience shooting back pains and radiating pain down the leg to the foot. It is not uncommon to experience tingling, numbness and weakness in the affected leg. As spondylolisthesis causes instability, symptoms may often worsen with increased activity or weight-bearing.
The most common cause of spondylolisthesis in adults is a degeneration from natural wear and tear due to ageing and arthritis.
The various types of spondylolisthesis include:
Spondylolisthesis is diagnosed using a combination of physical examination, medical history, X-rays, or other imaging. An MRI is often used to visualise the degree of compression of the spinal cord or nerves.
Treatment for spondylolisthesis depends on several factors:
Treatment usually begins with nonsurgical management, including medications, rest, steroid injections, and physiotherapy.
Surgery may be required if the vertebra continues to slip or the pain is not relieved by conservative treatment. Surgery aims to relieve the pain associated with an irritated nerve and stabilise the spine where the vertebra has slipped. The nerves exiting the spine must be decompressed to alleviate pain and neurological dysfunction. This will usually require a spinal fusion.