What is spondylolisthesis?

Spondylolisthesis is a condition in which a bone in the spine (a vertebra) slips forward or backward in relation to the bone below it. It occurs most frequently in the lower back, but any vertebra in the spine can be affected.

Low back pain, leg pain and weakness in the legs can happen if the bone that’s out of position significantly narrows the spinal column and begins to press on nerves.

Causes of spondylolisthesis

• Birth defect of the vertebral joint – This usually occurs in the lower spine where the lumbar spine and sacrum come together
• 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.

If it’s more severe, you may need physical therapy or surgery.

Spondylolisthesis grades

Doctors commonly describe spondylolisthesis as either high-grade or low-grade, depending on how severe your condition is. Grades are from 1 to 4.

• Low-grade (grade 1 and grade 2) usually occurs in adolescents and is considered less severe. Low-grade doesn’t typically require surgery.
• High-grade (grade 3 and grade 4) may require surgery if you’re experiencing severe pain.

The grade of your condition is based on how far away from proper alignment your spine has become.

Spondylolisthesis symptoms

In many cases, people who have spondylolisthesis don’t have any symptoms. You may not be aware you have the condition until an X-ray is taken for an unrelated reason. If you do have symptoms, the most common are:

• Lower back pain that feels like a muscle strain
• Muscle spasms or tightness in your hamstring
• Lower back pain that worsens with activity and improves with rest
• Difficulty walking or standing
• Pain when bending over
• Stiffness in your back
• Pain extending down from your lower back to your thighs

If you have high-grade spondylolisthesis, you may experience tingling, numbness or weakness in one or both legs.

Diagnosing spondylolisthesis

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

• X-rays
• Computed tomography (CT) scan
• Magnetic resonance imaging (MRI) scan
• Electromyography (EMG) to test your muscles and nerves

Spondylolisthesis treatment

Ohio State’s Spine Care team has the benefit of extra expertise from treating many people with spondylolisthesis. Because of this, the Spine Care team, composed of orthopedic and neurological specialists, is uniquely qualified to determine whether you’re likely to benefit from nonsurgical treatment. We also recommend lifestyle changes to prevent future problems with your spine.

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.

Lifestyle changes

• Exercise, such as Pilates or yoga, to strengthen muscles in your back
• Quitting smoking
• Guidance on weight loss to reduce pressure on your spine

Nonsurgical treatments

• Physical therapy – We’ll work with you one-on-one to customize a treatment plan for your needs and goals
• Spine orthobiologics use substances in your body to activate the healing process naturally
• Wearing a back brace to limit spine movement
• Medication for pain management
• Rest

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

Spondylolisthesis surgery

You may need surgery if a spinal 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 athletic activities.

Research

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

Those who have a pinched nerve may be eligible to participate in one of the following areas of research at The Ohio State University Wexner Medical Center.

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

Back pain consortium: We’re members of the International Consortium for Health Outcomes Measurement (ICHOM). Membership in this elite organization allows us to engage with other top U.S. medical centers in global research studies on back pain. As we measure our results against established international standards, we share best practices and elevate our standard of care.

Enroll in a clinical trial