What is spondylolisthesis?

Spondylolisthesis is a condition in which a bone (vertebra) in the spine slips forward or backward in relation to the bone below it. It occurs most frequently in the lower back but can affect any vertebra. Low back pain, leg pain and weakness in the legs can result if the bone that's out of position significantly narrows the spinal column and begins to press on nerves.

Causes of spondylolisthesis include:

  • Congenital (something you are born with) defect of the vertebral joint. This usually occurs in the lower spine where the lumbar spine and sacrum come together. The defect allows a lumbar vertebra to slip forward over the sacrum
  • Stress “micro-fracture” in the bone due to overstretching and overuse. This can occur with sports activities such as gymnastics, weight lifting, ice skating and football
  • Aging or overuse-related wear on the spinal joints
  • Fractures
  • Tumors

Rest and anti-inflammatory medication resolve most cases, but occasionally physical therapy or surgery may be required.

Spondylolisthesis grades

Like many other conditions, spondylolisthesis can be measured using a grading system, where your spondylolisthesis grade is based on the degree of displacement of your vertebrae. Grades of spondylolisthesis influence what symptoms you might experience as well as what treatment you will likely receive.

The grade of your condition is based on the distance from the posterior edge of the superior body of the vertebrae to the same edge of the inferior vertebral body. The ratings range from spondylolisthesis grade 1 to spondylolisthesis grade 5: grade 1 spondylolisthesis being least severe and grade 5 most severe. 

Learn more about brain and spine neurological conditions at The Ohio State University Wexner Medical Center.

Why choose Ohio State for treatment of spondylolisthesis?

Diagnosing spondylolisthesis

Following a thorough history, physical and neurological exams, our spine surgeons may recommend any of the following tests to confirm whether a bone in your spine is abnormally aligned. All tests are available at Ohio State Spine Care:

  • X-rays of the spine
  • Computed tomography (CT)
  • Magnetic resonance imaging (MRI)
  • Electromyography (EMG) studies—tests that measure the electrical activity of muscles and nerves

Spondylolisthesis treatment

Ohio State’s spine specialists have the benefit of extra expertise gathered from treating large volumes of patients with spondylolisthesis. Because of this, the Ohio State spine team is uniquely qualified to determine whether you’re likely to benefit from nonoperative care.

We offer treatments ranging from physical therapy to the most complex spine surgeries. Physicians, therapists and other care providers work together to provide you with options that increase mobility and reduce pain. Most people who come to Ohio State Spine Care don’t require surgery.

Nonsurgical treatments

One of Ohio State’s strengths is our physical therapy program, with therapists who specialize in spine conditions. Following an examination of posture, spine mobility, strength and flexibility, our physical therapists customize a plan for you. We take into account any impairments or functional limitations you have. Typically, you’ll work one-on-one with a therapist on pain-relieving movement strategies and on improvements in strength and flexibility. Additional nonsurgical treatments include:

  • Education on back care and recommendations for specific needs (such as job demands, recreational activities, home setup)
  • Real-time ultrasound imaging (RUSI) of movement in in the spine area to retrain the deep stabilizing musculature of your spine (a highly researched, evidence-based intervention)
  • Spine orthobiologics, also known as stem cell therapy, activates the body’s natural healing process through injections of the body’s own healthy cells into the injured area to stimulate tissue regeneration and natural healing
  • A back brace to limit spine movement
  • Oral or injected medication for pain management
  • Rest

Most people return slowly to full function, including athletic activity.

Spondylolisthesis surgery

You may need surgery if a bone that has slipped is likely to cause damage to nerves and the surrounding spinal structure, or if it’s causing severe pain or muscle weakness in one or both legs.

Our surgeons can perform minimally invasive surgery to correct the symptoms of spondylolisthesis. The surgeon makes tiny incisions in the back and works through a tube to minimize skin and muscle damage, reduce blood loss and reduce postsurgical pain.

At Ohio State, we can use both minimally invasive surgery and conventional surgical techniques for these procedures:

  • Decompression surgery (laminectomy) to remove part of the vertebra and relieve pressure on your spinal cord or nerves
  • Spinal fusion surgery to fuse a severely slipped bone with the vertebra below it and restore stability to the spinal column

Most people who have decompression or fusion surgery can return to full function, including sporting activities.



Ohio State performs innovative research in the laboratory, as well as through clinical trials. 

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Areas of focus include:

Spinal Fusion Study: A clinical trial currently under way at Ohio State is testing whether vertebrae being fused during minimally invasive surgery can be held together with screws on one side instead of on both sides of the bone. Placing screws on only one side of the bone results in shorter surgery time, less blood loss and less pain following surgery.

Biomechanical Testing: We also are doing biomechanical testing to assess the spine before and after surgery. A specialized vest helps us measure the effectiveness of surgery. It ultimately may provide valuable information about which treatment methods will best increase mobility and function of the spine.

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Additional Information

Please obtain a physician referral before scheduling with our Spine Center and request previous imaging studies (e.g., MRI, CT, X-ray) on a CD from the place where your tests were performed. Please bring to your appointment these and other test results related to your back (e.g., EMGs, bone density reports, ultrasound reports) from your doctor(s).

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