Condition and Causes

The spine is made of 33 bones called vertebrae. When one of these bones slips forward on the adjacent neighboring vertebra, this is called spondylolisthesis. This condition can cause back and leg pain, as well as other symptoms. Spondylolisthesis may be hereditary, or it may be the result of stress placed on the spine. It can also be due to spinal degeneration. This condition can gradually cause a deformity of the lower spine, and it can narrow the vertebral canal.

There are five different types of spondylolisthesis:

  • Dysplastic spondylolisthesis occurs when a defect in the facet allows the vertebra to slip forward. This type is congenital, meaning the patient is born with it.
  • Isthmic spondylolisthesis occurs when there is a defect in a portion of the vertebra called the pars interarticularis. This condition can be caused by repetitive trauma, and it is more evident in athletes who may hyperextend, like football linemen or gymnasts. However, if there is no slippage of a vertebra, the patient has spondylolysis. Isthmic spondylolisthesis can be further divided into three categories:
    • Type II A - Often called Lytic or stress spondylolisthesis, this type is likely caused by repeated micro-fractures due to hyperextension. This type is more common in males and is called a "stress fracture" of the pars interarticularii.
    • Type II B - Likely also occurs from micro-fractures in the pars interarticularii. This type is different from the preceding type in that the pars interarticularii stay intact, but stretch out as new bone fills in the fractures.
    • Type II C - Caused by an acute fracture of the pars interarticularii. This type is very rare, and may require nuclear imaging to firmly establish diagnosis.

Degenerative spondylolisthesis is caused by arthritic changes in the vertebral joints due to cartilage degeneration. This condition is more common in older patients.

Traumatic Spondylolisthesis is caused by injury or direct trauma to the vertebrae. In this type of Spondylolisthesis, a fracture of the lamina, pedicle or facet joints lets the front part of the vertebra to slip forward.

Pathologic Spondylolisthesis occurs when the bone is made structurally weak due to a disease, like a tumor or another bone disorder.

Symptoms and diagnosis

Lower back pain is the most common symptom of spondylolisthesis. The pain is often made worse by bending forward and relieved by bending back. The amount of pain experienced does not correlate to the degree to which the vertebra has slipped. Leg pain may also be felt, which may be due to narrowing of the space where the nerves leave the spinal canal.

Half of patients with spondylolisthesis will associate the onset of their symptoms with an injury. Often a patient will lay the groundwork for the injury earlier on in life by developing a lesion. This lesion may not develop into spondylolisthesis until much later in life.

There is usually little deformity detectable, and range of motion is not usually impacted. Often, tightness of the hamstring muscles is the first physical sign of spondylolisthesis. Back pain may occur at irregular intervals, particularly when arching the back. If a nerve is being pinched by spondylolisthesis, a patient may display symptoms similar to those seen with a herniated disc, including muscle weakness of the legs, numbness or tingling in the feet and leg pain.


Treatment varies, depending on if the type of slip, the patient's age and symptoms, and whether pressure is being put on nerves. For those whose nerves are not affected by the vertebral slippage, treatment starts with non-surgical treatments like medication and physical therapy. Bracing may also be recommended. If symptoms are manageable and the slip is small, the treatment will likely be observation. Activity restrictions may be necessary for children, like abstaining from certain sports.

If the slip is more severe or symptoms of nerve compression are present, surgery may be recommended. Surgeries for this condition include spinal decompression, where bone is removed to make room for the nerve being compressed, or spinal fusion. These surgeries are often done at the same time.

Risks and benefits

Failure to take preventive measures for any spinal condition may result in a further aggravated condition. Surgical measures for advanced cases may give relief from extremity pain. The risks involved with surgery are common - infection, blood loss, damage to nerves and spine - and some specific to your treatment. This material is intended to give the patient an overview of surgical procedures and treatments and is not intended to replace the advice and guidance of a physician. Always consult with your doctor about the particular risks and benefits of your treatment.

All information provided on this website is for information purposes only. Please see a healthcare professional for medical advice. If you are seeking this information in an emergency situation, please call 911 and seek emergency help.

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You may be a candidate for Endoscopic Foraminotomy


Over the years, we ask a lot of our spine. Through a person’s lifetime, this interdependent and essential structure helps support the weight of the upper body, protects the spinal cord and facilitates movement. Eventually, the strain that results from these responsibilities begins to have consequences. Intervertebral discs lose water content and the structural quality of the vertebral column starts to deteriorate. Besides the general wear and tear that occurs as we age, spinal injuries can happen at any point in an individual’s life. Traumatic injuries often happen suddenly and may disrupt proper functioning. All of these factors generally contribute to the development of harmful spinal complications.

The term “spondylolisthesis” refers to one such condition that occurs when a vertebra in the spine slips forward and slides over the bone below it. Although spondylolisthesis most commonly occurs in the lumbar (lower back) region, this condition may develop in the cervical (neck) and thoracic (middle back) areas of the spine as well. Oftentimes, spondylolisthesis will place tremendous pressure on the spinal cord and surrounding nerves, which in turn leads to intense pain and discomfort. Some patients may experience no symptoms or delayed symptoms that surface well after the original post-vertebral slip. Others will notice immediate discomfort as soon as the vertebra shifts. If spondylolisthesis is causing pain and other debilitating symptoms, there are many safe, evidence-based methods to address this condition and encourage restoration to a patient’s quality of life.


Spondylolisthesis most often ensues after a fracture, but there are many causes that can contribute to this disorder, including:

  • Congenital defective joints, genetics and family history
  • Sudden injuries or traumas which commonly occur as the result of manual labor, high-impact sports, hard falls or unexpected accidents
  • Overuse of the affected joint
  • Frequent, improper movements or lifting
  • Aging and general wear and tear associated with the aging process
  • Infection
  • Arthritis
  • Conditions, such as degenerative disc disease, that affect the behavior of intervertebral discs
  • Obesity
  • Lack of exercise
  • Malnutrition
  • Smoking and the excessive consumption of alcohol

The above causes play a central role in many back-related conditions besides spondylolisthesis. For this reason, it is important to seek medical attention as soon as you realize you are experiencing a spine complication. Receiving an accurate, prompt diagnosis will better your chances of attaining the most optimal treatment possible.


The symptoms of spondylolisthesis vary widely depending on the location and severity of the displaced vertebrae. However, some of the most common indicators of spondylolisthesis are:

  • Pain or numbness in the buttocks or legs, if spondylolisthesis has occurred in the lower back region
  • Weakness in lower back and affected extremities
  • Difficulty walking and performing other everyday tasks
  • Low back pain that worsens when a patient twists or bends over
  • Sciatica

Some patients encountering spondylolisthesis may have no symptoms at all. The problems associated with this condition usually only arise when the problematic vertebrae begins to compress one or more nearby nerves.

Our Microspine & Minimally Invasive Treatment Approach

If left untreated, spondylolisthesis can lead to an array of related spine complications and may begin to significantly impact your health and well-being. By proactively addressing spondylolisthesis, you can take control of your condition and lessen or even eliminate inhibiting symptoms. From diagnosis to recovery, Dr. T is committed to helping you achieve a pain-free life, so that you can return to the activities you love faster.

The first step toward finding relief from spondylolisthesis is to schedule a consultation at one of our conveniently located spine clinics. During this initial visit, Dr. T will attentively evaluate your medical history, physical state and symptoms. To diagnose spondylolisthesis and determine its severity, a C.T. scan, MRI or X-ray may be required. This also helps us to rule out other, similar conditions.

Whenever possible, we encourage patients to consider conservative, non-invasive treatments before looking into surgical intervention. Spondylolisthesis can be responsive to non-surgical treatments, such as:

  • Physical Therapy: When combatting spondylolisthesis, the primary goals of physical therapy are to strengthen the core muscles which support the spine. In addition, physical therapy may help patients improve their flexibility and lose excess pounds. Being overweight or obese can worsen spondylolisthesis by placing immense pressure on the spine and leading to additional difficulties within the back region.
  • Medication: Anti-inflammatory and pain-relieving medications can reduce the amount of discomfort caused by spondylolisthesis.
  • Additional Modifications: For some patients, assistive devices, heating and cooling therapies, a limited period of rest or other alternative treatments may be recommended. Every component of care depends upon the patient’s unique case of spondylolisthesis, as well as their goals and lifestyle.

In cases where spondylolisthesis is causing the vertebrae to continually move or in situations where the spine requires stabilization, surgical intervention may be necessary right away.

Some patients may need only Microspine endoscopic decompression utilizing extremely small incisions and tiny cameras without fusion whereas others may need Minimally invasive spine fusion (MIS-TLIF) which Dr.T can customized and tailored each approach for each of his patients as there is no “one size fits all” in medicine.

The Microspine & minimally invasive surgeries available that we offer generally lead to:

  • Shortened recovery times that enable patients to return to their daily routines and lives more quickly
  • Less post-operative pain than what is statistically linked to traditional open surgeries
  • A minimal risk of scarring or trauma to surrounding tissues

Significantly reduced blood loss than what is typically experienced in open back surgery 

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