Spondylolisthesis
Forward slippage of one vertebra over another — a common source of lower back pain
ICD-10: M43.1 · lumbar condition
Spondylolisthesis occurs when one vertebra slides forward (or less commonly backward) over the one below it. It is graded I through IV based on the percentage of slip. Grade I and II slips are most common and usually managed without surgery. Grade III and IV slips — or lower-grade slips with significant nerve compression — may require surgical stabilization. The most common type in adults is degenerative spondylolisthesis, which most frequently affects the L4-L5 level.
5–6%
Spondylolisthesis affects approximately 5–6% of the adult population, with the L4–L5 and L5–S1 levels most commonly involved.
American Academy of Orthopaedic Surgeons80%
Approximately 80% of patients with Grade I or II spondylolisthesis can be managed effectively without surgery through physical therapy and activity modification.
North American Spine Society66%
The SPORT trial showed surgery for degenerative spondylolisthesis produced significantly greater improvement than non-operative treatment in 66% of patients at 2-year follow-up.
Weinstein JN et al., New England Journal of Medicine (2007)Symptoms
- Lower back pain, often worse with prolonged standing or walking
- Buttock pain radiating into the legs (neurogenic claudication)
- Numbness or tingling in one or both legs
- Tight hamstrings (a common early sign in adolescents)
- Visible abnormality in posture or gait in severe cases
- Bladder or bowel dysfunction in severe, high-grade slips
Causes & Risk Factors
- Degenerative — wear to the facet joints allowing forward slip (most common in adults over 50)
- Isthmic — stress fracture of the pars interarticularis (common in young athletes)
- Traumatic — acute injury causing vertebral displacement
- Pathological — bone disease (e.g., osteoporosis, tumor) weakening the posterior arch
- Iatrogenic — post-surgical instability following laminectomy
Treatment Options
Conservative
- Physical therapy focused on core stabilization and lumbar extension exercises
- Activity modification — avoiding high-impact and hyperextension activities
- Anti-inflammatory medications and epidural steroid injections
- Bracing in selected cases, especially for isthmic spondylolisthesis in adolescents
- Weight management to reduce mechanical loading
Surgical
- Posterior lumbar interbody fusion (PLIF) or TLIF — most common surgical approach
- Posterolateral fusion with pedicle screw fixation
- Minimally invasive MIS-TLIF for reduced recovery time
- Reduction of high-grade slips combined with fusion (specialized cases)
When to see a spine specialist
See a spine specialist if low back pain is persistent, especially if it radiates into the legs or is accompanied by weakness. Athletes with low back pain lasting more than 2 weeks that doesn't improve should be evaluated for isthmic spondylolisthesis.
Specialists Who Treat Spondylolisthesis
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Search spine specialists →Frequently Asked Questions
Can spondylolisthesis get worse over time?
Low-grade slips (Grade I and II) often remain stable for years. However, especially in degenerative spondylolisthesis, the slip can slowly progress over decades. Regular monitoring with periodic X-rays helps track progression. Rapid progression or worsening neurological symptoms warrant more urgent evaluation.
Is spondylolisthesis the same as spondylolysis?
No, though they are related. Spondylolysis is a stress fracture of the pars interarticularis — a small bone bridge connecting the upper and lower joints of a vertebra. It does not involve vertebral slippage. When this fracture causes the vertebra to slide forward, that is called isthmic spondylolisthesis.
What percentage of people with spondylolisthesis need surgery?
The majority — roughly 80% — of patients with spondylolisthesis (especially Grade I and II) can be managed effectively without surgery. Surgery is considered when conservative care fails after 3–6 months, when there is neurological deficit (weakness or bowel/bladder changes), or when the slip is high-grade (III or IV).