Spondylolisthesis

Relief for spinal instability and nerve compression caused by vertebral slippage

Spondylolisthesis occurs when one vertebra shifts forward relative to the vertebra beneath it. This displacement can contribute to mechanical back pain, nerve compression, and reduced spinal stability. The condition most commonly affects the lumbar spine, though it can occur at other spinal levels.

At Resolution Spine & Joint, we provide comprehensive evaluation and targeted treatments designed to reduce pain, improve stability, and restore function while helping many patients avoid surgery.

Common Symptoms

Symptoms vary depending on the degree of slippage and nerve involvement and may include:

• Low back pain

• Muscle tightness or spasms

• Radiating leg pain (radiculopathy)

• Numbness or tingling in the legs

• Weakness

• Pain worsened with standing, walking, or extension movements

• Reduced walking tolerance

Some patients also report a sensation of instability or fatigue in the lower back.

Types of Spondylolisthesis

Degenerative Spondylolisthesis

• Most common in adults

• Occurs due to disc degeneration and facet joint arthritis

• Often associated with spinal stenosis

Isthmic Spondylolisthesis

• Caused by a defect or stress fracture in the pars interarticularis

• Often develops earlier in life

• May become symptomatic later with degeneration

Traumatic Spondylolisthesis

• Result of acute injury disrupting spinal stability

Congenital Spondylolisthesis

• Related to developmental abnormalities of spinal structures

Pathologic Spondylolisthesis

• Occurs due to weakened bone from disease or tumor

Understanding the underlying type helps guide treatment and prognosis.

Grading of Vertebral Slippage

Spondylolisthesis is commonly classified by the degree of forward displacement:

• Grade I: Mild slippage (0–25%)

• Grade II: Moderate slippage (25–50%)

• Grade III: Advanced slippage (50–75%)

• Grade IV: Severe slippage (75–100%)

Symptom severity does not always correlate directly with the grade.

How Spondylolisthesis Causes Pain

Pain may arise from several mechanisms:

• Mechanical instability and muscle fatigue

• Facet joint overload

• Disc degeneration

• Foraminal narrowing and nerve compression

• Spinal canal narrowing (stenosis)

Often, symptoms reflect a combination of instability and nerve irritation.

Diagnosis

Evaluation typically includes:

• Detailed clinical history and physical examination

• Assessment of neurologic function and spinal stability

• X-rays to assess vertebral alignment and movement

• MRI imaging to evaluate nerve compression and disc health

• Dynamic imaging when instability is suspected

Diagnosis focuses on correlating imaging findings with symptoms and functional limitations.

Treatment Options at Resolution Spine & Joint

Treatment aims to improve stability, reduce inflammation, and relieve nerve irritation.

Conservative Management

• Physical therapy emphasizing core stabilization

• Activity modification and movement retraining

• Anti-inflammatory strategies when appropriate

• Bracing in selected cases

Interventional Treatments

• Epidural steroid injections for nerve-related symptoms

• Facet joint and medial branch interventions for mechanical pain

• Selective nerve root blocks for radicular symptoms

• Sacroiliac joint treatment when pelvic compensation contributes

Targeted interventions often improve function by reducing both inflammation and mechanical stress.

Potential Consequences if Untreated

• Progressive back pain

• Nerve compression and radiculopathy

• Reduced mobility and activity tolerance

• Muscle fatigue and compensatory pain patterns

• Worsening spinal instability in select cases

Early treatment helps preserve function and minimize symptom progression.

When to Seek Evaluation

Evaluation is recommended when:

• Persistent low back pain develops

• Leg symptoms or numbness occur

• Walking tolerance decreases

• Pain worsens with standing or extension activities

Prompt evaluation helps guide appropriate stabilization and symptom management.

Why Choose Resolution Spine & Joint

• Expertise in diagnosing spinal instability and nerve compression

• Advanced image-guided interventional treatments

• Individualized stabilization and rehabilitation strategies

• Rapid access to evaluation and targeted care

• Collaborative approach when surgical consultation is appropriate

Thoughtful management often allows patients to remain active and avoid unnecessary surgical intervention.

Frequently Asked Questions

Can spondylolisthesis heal on its own?
Structural slippage typically remains, but symptoms can be effectively managed.

Is exercise safe?
Yes. Stabilization-focused exercise is often beneficial and protective.

Does slippage always worsen over time?
Many cases remain stable, particularly with appropriate strengthening and activity modification.

When is surgery considered?
Surgery may be discussed when severe instability or neurologic symptoms persist despite conservative care.

References

• North American Spine Society (NASS)

• American Academy of Orthopaedic Surgeons (AAOS)

• American Society of Interventional Pain Physicians (ASIPP)