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Spondylolisthesis

By

Peter J. Moley

, MD, Hospital for Special Surgery

Last full review/revision Nov 2020| Content last modified Nov 2020
Click here for the Professional Version
Topic Resources

Spondylolisthesis is partial displacement of a bone in the lower back.

  • Injuries or a degenerative condition can cause this disorder.

  • Pain is felt in the low back and may travel down one or both legs.

  • The diagnosis is based on the results of imaging tests.

  • Treatment includes measures to relieve pain.

The spine (spinal column) consists of back bones (vertebrae) stacked one on top of another. In lumbar spondylolisthesis, a vertebrae in the lower back slips forward. This disorder usually occurs during adolescence or young adulthood (often in athletes). It is usually caused by a birth defect or an injury that causes fractures (breaks) in a part of the vertebra. If both sides of the vertebra are involved, the vertebra can then slip forward over the one below it. Spondylolisthesis can also occur in older adults, mainly as the result of a degenerative condition such as osteoarthritis. People who develop spondylolisthesis as adults are at risk of developing lumbar spinal stenosis.

Symptoms of Spondylolisthesis

Mild to moderate spondylolisthesis may cause little or no pain, particularly in young people.

When pain occurs in adolescents, it is felt on only one side of the spine and may travel down a leg. The pain may accompany a fracture.

When pain occurs in adults, it is felt over a specific part of the spine and travels down both legs. In these cases, the pain results from a degenerative condition.

Pain is worsened by standing or leaning back. It can be accompanied by numbness, weakness, or both in the legs.

Diagnosis of Spondylolisthesis

  • Imaging tests

Doctors base the diagnosis of spondylolisthesis on imaging tests, usually x-rays taken of the lower spine.

Other imaging tests, such as magnetic resonance imaging (MRI) or sometimes computed tomography (CT), may be done.

Treatment of Spondylolisthesis

  • Measures to relieve pain and stabilize the spine

One to two days of bed rest may provide pain relief for people with spondylolisthesis. Longer bed rest weakens the core muscles and increases stiffness, thus worsening back pain and prolonging recovery. Sleeping in a comfortable position on a medium mattress is recommended. People who sleep on their back can place a pillow under their knees. People who sleep on their side should use a pillow to support their head in a neutral position (not tilted down toward the bed or up toward the ceiling). They should place another pillow between their knees with their hips and knees bent slightly if that relieves their back pain. People can continue to sleep on their stomach if they are comfortable doing so.

Applying cold (such as ice packs) or heat (such as a heating pad) or using over-the-counter analgesics (such as acetaminophen and nonsteroidal anti-inflammatory drugs [NSAIDs]) may help relieve the pain. Some people may be helped by drugs that reduce nerve pain, such as gabapentin, antiseizure drugs, or certain antidepressants. If pain is severe or persists, doctors may give corticosteroids taken by mouth or injected into the epidural space (between the spine and the outer layer of tissue covering the spinal cord).

Physical therapy and exercises to strengthen and stretch the muscles in the abdomen, buttocks, and back (the core muscles) may help. (See also Low Back Pain: Prevention.)

Drugs Mentioned In This Article

Generic Name Select Brand Names
TYLENOL
NEURONTIN
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