L186/ 100
Journal of orthopaedic surgery and research·2026·Meta-analysis
Retrolisthesis
Backward displacement of a vertebral body — the reverse of spondylolisthesis
ICD-10: M43.12 · lumbar condition
Retrolisthesis is a backward (posterior) displacement of one vertebral body relative to the vertebra directly below it. It is the reverse of spondylolisthesis, which involves forward slippage. Retrolisthesis most commonly occurs in the lumbar and cervical spine and is typically a degenerative condition, though it can also follow trauma. The backward displacement is graded by the proportion of the vertebral body's width that has shifted: Grade 1 (up to 25%), Grade 2 (25–50%), Grade 3 (50–75%), and Grade 4 (75–100%). While small amounts of retrolisthesis are common and may be asymptomatic, clinically significant retrolisthesis narrows the spinal canal from the back and can compress nerve roots or the spinal cord.
6–23%
Retrolisthesis is present in approximately 6–23% of patients with degenerative lumbar disc disease, with higher rates in older patients and those with greater disc height loss.
Quint U et al., European Spine Journal (2009)15%
Retrolisthesis of 2 mm or more is found in up to 15% of asymptomatic adults over 60 on standing lumbar X-ray.
North American Spine SocietySymptoms
- Low back or neck pain localized to the affected segment
- Muscle stiffness and reduced spinal flexibility at the retrolisthetic level
- Radiculopathy — arm or leg pain, numbness, or weakness from nerve root compression
- Myelopathy symptoms if spinal cord is compressed (in cervical retrolisthesis)
- Pain that worsens with extension and may improve with forward flexion
- Muscle spasm as a protective response to the instability
Causes & Risk Factors
- Degenerative disc disease — disc height loss allows posterior displacement
- Facet joint arthrosis — worn posterior joints that no longer restrain backward motion
- Prior surgery — discectomy that alters the biomechanics of the segment
- Trauma — hyperextension injury that damages anterior disc or ligamentous structures
- Osteoporosis — vertebral endplate changes that allow posterior displacement
Imaging Findings
Imaging studies are commonly used to identify findings associated with this condition. Results vary by individual; a qualified spine specialist interprets findings in the context of a full clinical evaluation.
MRI
- Posterior displacement of the upper vertebra relative to the lower vertebra — often 2–4 mm at lumbar levels
- Disc degeneration at the retrolisthetic level is uniformly present and drives the posterior slip
- Posterior disc herniation or foraminal encroachment from the posterior displacement
- Ligamentum flavum buckling contributing to central canal or lateral recess narrowing
- Note: Mild retrolisthesis (<4 mm) is common in the context of degenerative disc disease and may be asymptomatic
CT Scan
- Posterior offset of vertebral body end plate on sagittal reconstruction
- Facet joint orientation and arthrosis at the retrolisthetic level
- Degree of posterior bony impingement on neural structures
X-Ray
- Lateral standing view: posterior displacement of vertebral body relative to adjacent levels
- Most commonly seen at L4–5 or L5–S1 in association with disc degeneration
- Flexion-extension views: instability if >3 mm translation or >15° angular change
Who Is Commonly Affected
The following patterns are commonly associated with this condition based on published population studies. Individual presentation varies; these figures are informational only.
Peak Age Range
50–70 years
Gender Distribution
Female predominance in most series, especially at L4–5
Estimated Prevalence
Present in approximately 5–20% of adults undergoing lumbar MRI; prevalence increases with degree of disc degeneration
Treatment Options
Conservative
- Physical therapy — core stabilization and lumbar muscle strengthening
- NSAIDs for pain and inflammation
- Postural training and ergonomic assessment
- Epidural steroid injections for radiculopathy
- Spinal brace for symptomatic relief during activity
Surgical
- Lumbar fusion — for symptomatic retrolisthesis with neurological deficits or refractory pain, reducing the slip and stabilizing the segment
- Cervical fusion (ACDF or posterior) — for cervical retrolisthesis with myelopathy or radiculopathy
When to see a spine specialist
See a spine specialist if you have been diagnosed with retrolisthesis and experience progressive radiculopathy, neurological deficits, or pain that is not responding to conservative care. Retrolisthesis found incidentally without symptoms can typically be managed with observation and physical therapy.
Specialists Who Treat Retrolisthesis
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Questions to Ask Your Doctor
Bring these questions to your next appointment about retrolisthesis.
- 1
What is the degree of my posterior slippage, and at which level — does it match my pain location?
- 2
Is the retrolisthesis stable or dynamic — should I have flexion-extension imaging to assess movement?
- 3
Is the retrolisthesis causing nerve root compression, or is my pain more likely from the associated disc degeneration?
- 4
Can physical therapy focused on lumbar stabilization reduce the symptoms associated with my retrolisthesis?
- 5
At what point would surgical stabilization be considered for my degree of retrolisthesis?
Clinical Evidence
Key Research
- L4Prevalence and Risk Factors of Degenerative Spondylolisthesis and Retrolisthesis in the Thoracolumbar and Lumbar Spine
- L4Physical and radiographic features of degenerative retrolisthesis in Japanese female volunteers: an observational study
- L4Lumbar Retrolisthesis in Aging Spine: What are the Associated Factors?
- L4Retrolisthesis and lumbar disc herniation: a postoperative assessment of outcomes at 8-year follow-up
Frequently Asked Questions
Is retrolisthesis the same as spondylolisthesis?
No — they are opposite directions of vertebral slippage. Spondylolisthesis is forward (anterior) slippage; retrolisthesis is backward (posterior) slippage. Both can be graded by the degree of displacement and both may be asymptomatic or symptomatic depending on severity. Spondylolisthesis is more common and has more extensive clinical literature. Retrolisthesis is less well-studied but causes similar symptoms through nerve root or spinal cord compression.
How is retrolisthesis measured?
Retrolisthesis is measured on standing lateral lumbar or cervical X-ray by comparing the posterior wall of the superior vertebral body to the posterior wall of the inferior vertebral body. A displacement of 2 mm or more posteriorly is generally considered clinically significant. Flexion-extension X-rays can demonstrate dynamic retrolisthesis that changes with position and may indicate segmental instability.
Can retrolisthesis worsen over time?
Yes — degenerative retrolisthesis typically worsens as disc height loss and facet arthropathy progress at the affected level. However, the rate of progression is variable and many patients remain stable for years. Patients with confirmed retrolisthesis benefit from core stabilization programs that maintain muscular support of the unstable segment and may slow progression.