Spondylolisthesis

In children, spondylolisthesis usually occurs between the fifth bone in the lower back (lumbar vertebra) and the first bone in the sacrum (pelvis) area. It is often due to a birth defect in that area of the spine or sudden injury (acute trauma).

In adults, the most common cause is abnormal wear on the cartilage and bones, such as arthritis. The condition mostly affects people over 50 years old. It is more common in women than in men.

Bone disease and fractures can also cause spondylolisthesis. Certain sports activities, such as gymnastics, weightlifting, and football, greatly stress the bones in the lower back. They also require that the athlete constantly overstretch (hyperextend) the spine. This can lead to a stress fracture on one or both sides of the vertebra. A stress fracture can cause a spinal bone to become weak and shift out of place.

Symptoms of spondylolisthesis may vary from mild to severe. A person with spondylolisthesis may have no symptoms. Children may not show symptoms until they're 18 years old.

The condition can lead to increased and abnormal lordosis (also called swayback). In later stages, it may result in kyphosis (roundback) as the upper spine falls off the lower spine.

Symptoms may include any of the following:

• Lower back pain
• Muscle tightness (tight hamstring muscle)
• Pain, numbness, or tingling in the thighs and buttocks
• Stiffness
• Tenderness in the area of the vertebra that is out of place
• Weakness in the legs

Your health care provider will examine you and feel your spine. You will be asked to raise your leg straight out in front of you. This may be uncomfortable or painful.

X-ray of the spine can show if a bone in the spine is out of place or broken.

CT scan or MRI scan of the spine can show if there is any narrowing of the spinal canal and pinching of your nerves.

Treatment depends on how severely the vertebra has shifted out of place. Most people get better with exercises that stretch and strengthen lower back muscles.

If the shift is not severe, you can play most sports if there is no pain. Most of the time, you can slowly resume activities.

You may be asked to avoid contact sports or to change activities to protect your back from being overextended.

You will have follow-up x-rays to make sure the problem is not getting worse.

Your provider may also recommend:

• A back brace to limit spine movement
• Pain medicine (taken by mouth or injected into the back)
• Physical therapy

Surgery may be needed to fuse the shifted vertebrae if you have:

• Severe pain that does not get better with treatment
• A severe shift of a spine bone
• Weakness of muscles in one or both of your legs
• Difficulty with controlling your bowels and bladder

There is a chance of nerve injury with such surgery. However, the results can be very successful.

Exercises and changes in activity are helpful for most people with mild spondylolisthesis.

If too much movement occurs, the bones may begin to press on nerves. Surgery may be necessary to correct the condition.

Other complications may include:

• Long-term (chronic) back pain
• Infection
• Temporary or permanent damage of spinal nerve roots, which may cause sensation changes, weakness, or paralysis of the legs
• Difficulty controlling your bowel and bladder
• Arthritis that develops above the level of the slippage

Contact your provider if:

• The back appears to have a severe curve
• You have back pain or stiffness that does not go away
• You have pain in the thighs and buttocks that does not go away
• You have numbness and weakness in legs
• You have trouble controlling bowel movements or urination

Low back pain - spondylolisthesis; LBP - spondylolisthesis; Lumbar pain - spondylolisthesis; Degenerative spine - spondylolisthesis

Porter AST. Spondylolisthesis. In: Giangarra CE, Manske RC, eds. Clinical Orthopaedic Rehabilitation: A Team Approach. 4th ed. Philadelphia, PA: Elsevier; 2018:chap 80.

Williams KD. Spondylolisthesis. In: Azar FM, Beaty JH, eds. Campbell's Operative Orthopaedics. 14th ed. Philadelphia, PA: Elsevier; 2021:chap 40.

Updated by: C. Benjamin Ma, MD, Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.