Spondylolisthesis

Spondylolisthesis is a condition in which one vertebra slips forward over the bone beneath it, most often in the lower back. The slip can narrow the space for the nerves and cause back or leg symptoms, although some people have no symptoms at all.

• Low back pain or stiffness, often worse with standing and activity
• Pain, numbness, or pins-and-needles that travels into the buttocks or down the legs
• Leg heaviness or weakness with standing or walking that eases when sitting or leaning forward
• Tight hamstring muscles
• Tenderness over the slipped vertebra

Adults most often have one of two types:

• Degenerative spondylolisthesis comes from age-related wear of the discs, facet joints, and ligaments that normally hold the vertebrae in line. It is most common after age 50 and in women.
• Isthmic spondylolisthesis starts with a small stress fracture in a part of the vertebra called the pars interarticularis (spondylolysis), usually in childhood or the teen years. The fracture may cause no trouble for years and first become painful in adulthood.

Sports that repeatedly arch the lower back, such as gymnastics, football, and weightlifting, raise the chance of a pars stress fracture in young athletes. Less commonly, a slip results from a difference in spine development present at birth, an injury, or bone disease.

A clinician examines your back, posture, flexibility, strength, sensation, and reflexes. Standing X-rays show the slip and how far it has moved; X-rays taken while bending forward and backward show whether the vertebra shifts with motion. An MRI shows pressure on the nerves and narrowing of the spinal canal, and a CT scan gives detailed images of the bone, including pars fractures. Follow-up X-rays are sometimes used to check whether a slip is changing.

Most people are treated without surgery. Non-surgical care includes a break from activities that worsen symptoms, physical therapy to strengthen the abdominal and back muscles and stretch tight hamstrings, anti-inflammatory or other pain medications when appropriate, and image-guided steroid injections for leg pain. A brace is sometimes used for a short time. These treatments do not move the vertebra back into place, but they can relieve symptoms.

Surgery may be considered when back or leg symptoms remain disabling despite a sustained course of non-surgical care, when weakness is worsening, or when there are problems with bladder or bowel control. Options include decompression to free the pinched nerves, with or without a spinal fusion that stabilizes the slipped level using bone graft, screws, and rods. For some younger patients with a pars fracture and healthy discs, a direct repair of the fracture may be an option. The right approach depends on the type of slip, how much it moves, and your overall health.

With non-surgical care, many people manage symptoms with a regular exercise program and activity adjustments. Young athletes may return to sport once pain-free, guided by their clinician.

After surgery, walking usually begins within a day or so. A fusion takes months to become solid, so bending, lifting, and twisting are limited during early healing, and strenuous activities return gradually with physical therapy and your surgeon's guidance.

• Keep the core and back muscles strong
• Maintain a healthy weight
• For young athletes, use proper technique and report low back pain that lasts more than a couple of weeks, especially in sports that involve repeated back arching