Spondylolisthesis
Spondylolisthesis occurs when one vertebra slips forward over the one below it. While this sounds concerning, many cases can be managed effectively with proper treatment. Understanding your specific type and grade helps determine the best approach.
Experiencing symptoms of spondylolisthesis?
Schedule a consultation with Dr. Marc Greenberg to explore minimally invasive options.
Spondylolisthesis happens when one vertebra slides forward over the vertebra below it. This condition can occur at any age but is most common in the lower back. The amount of slippage is measured in grades, which helps determine the best treatment approach.
At Greenberg Spine, Dr. Greenberg brings expertise from fellowship training at Mayo Clinic, Johns Hopkins, and Brown University to provide comprehensive care for spondylolisthesis. Our approach focuses on stabilizing the spine while preserving as much normal function as possible.
Symptoms
Lower back pain
Aching pain in the lower back, often worse with standing or walking
Leg pain
Pain radiating down one or both legs, similar to sciatica
Muscle spasms
Tightness and spasms in the back and leg muscles
Difficulty walking
Trouble walking long distances or standing for extended periods
Numbness or weakness
Loss of sensation or strength in the legs (in severe cases)
Causes
Stress fractures
Small cracks in the vertebra from repetitive stress or sports activities
Degenerative changes
Age-related wear and tear of joints and ligaments
Congenital defects
Born with abnormal vertebral development
Trauma
Injury from accidents or falls that damage spinal structures
Diagnosis
Physical Examination
Dr. Greenberg evaluates your posture, range of motion, and performs specific tests to assess spinal stability and nerve function.
- Posture assessment
- Neurological testing
- Stability evaluation
X-ray Imaging
Standing X-rays with flexion and extension views show the degree of slippage and any instability with movement.
- Slippage measurement
- Instability assessment
- Grading determination
MRI and CT Scans
Advanced imaging reveals nerve compression, disc health, and helps plan surgical approach when needed.
- Nerve compression evaluation
- Disc condition assessment
- Surgical planning
Conservative Treatment
Many cases of spondylolisthesis, especially low-grade slips, can be managed successfully without surgery through comprehensive conservative care.
Physical Therapy
Core strengthening and flexibility exercises to stabilize the spine
Bracing
Lumbar support braces to limit motion and provide stability
Medications
Anti-inflammatory drugs and muscle relaxants for pain management
Activity Modification
Avoiding activities that worsen symptoms while maintaining fitness
Injections
Epidural steroid injections to reduce nerve inflammation
Monitoring
Regular X-rays to track any progression of the slippage
When to Consider Surgery
Surgery is recommended for high-grade slips, progressive slippage, persistent symptoms after conservative treatment, or when neurological problems develop.
Surgical Indications
- High-grade slips (Grade III-V)
- Progressive slippage on X-rays
- Persistent pain after 6 months of conservative care
- Neurological symptoms (weakness, numbness)
Why Greenberg Spine
Our advanced surgical approach includes:
- Robotic-assisted precision for optimal screw placement
- Minimally invasive techniques when possible
- Motion-preserving options for select cases
- Outpatient procedures when appropriate
Related Procedures
Lumbar Fusion TLIF/PLIF
Stabilization procedure to prevent further slippage and relieve symptoms.
Robotic Spinal Fusion
Precision robotic-assisted fusion for optimal screw placement and alignment.
Lumbar Laminectomy
Decompression procedure often combined with fusion for spondylolisthesis.
Recovery Expectations
Conservative Treatment
Recovery focuses on strengthening and stabilizing the spine while monitoring for any progression of the slip.
Weeks 1-4
Pain management and gentle movement
Weeks 4-12
Progressive strengthening and stability training
3-6 Months
Return to activities with ongoing monitoring
Surgical Recovery
Fusion surgery requires time for bone healing, but most patients experience significant pain relief within weeks.
Weeks 1-6
Initial healing and gradual mobilization
Weeks 6-12
Physical therapy and activity progression
3-6 Months
Bone fusion completion and full activity return
Frequently Asked Questions
What causes spondylolisthesis?
Spondylolisthesis can be caused by stress fractures (spondylolysis), degenerative changes, congenital defects, or trauma. The most common types are isthmic (from stress fractures) and degenerative (from arthritis).
How is spondylolisthesis graded?
Spondylolisthesis is graded from I to V based on the percentage of vertebral slippage: Grade I (0-25%), Grade II (25-50%), Grade III (50-75%), Grade IV (75-100%), and Grade V (complete displacement).
When is surgery needed for spondylolisthesis?
Surgery is considered for high-grade slips (Grade III-V), progressive slippage, persistent pain after conservative treatment, or neurological symptoms like weakness or numbness.
Can spondylolisthesis get worse over time?
Some cases can progress, especially in children and adolescents with isthmic spondylolisthesis. Regular monitoring with X-rays helps track any progression and guide treatment decisions.
What is the success rate of fusion surgery?
Modern fusion techniques, especially robotic-assisted procedures, have success rates of 90-95% for achieving solid fusion and significant pain relief in appropriately selected patients.
Ready to Address Your Spondylolisthesis?
Schedule a consultation with Dr. Greenberg to explore both conservative and surgical treatment options.
Medical Disclaimer: The information provided on this page is for educational purposes only and should not be considered medical advice. Always consult with a qualified healthcare provider for proper diagnosis and treatment recommendations. Individual results may vary.
Source: American Association of Neurological Surgeons (AANS) and North American Spine Society (NASS) clinical guidelines.