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Jan 18, 2023

Cervical Spondylolisthesis Symptoms, Causes, & Treatments

What Causes Cervical Spondylolisthesis?

Like lumbar spondylolisthesis, spondylolisthesis in the neck can also be brought on by a defect of the bones in the neck as a result of hyperextension trauma. This fracture to the bony ring is known as cervical spondylolysis.

Some believe that congenital types of cervical spondylolisthesis exist that can make one more prone to cervical spine spondylolisthesis.

The severity of your cervical spondylolisthesis is measured by the degree of slippage of our vertebrae. There are five different grades of spondylolisthesis , grade I being least severe, and grade V being most severe.

What Makes Me More Prone to Cervical Spondylolisthesis?

• Injuries to the neck
• Genetic factors
• Straining your neck or holding it in the wrong position for long period of time
• Being an overweight or plus size individual

Cervical Spondylolisthesis Symptoms

• Pain around your shoulder blade region
• Pain that increases when you stand, sit, twist, or move your neck backward
• Headaches in the back of your neck
• Difficulty grabbing or holding on to objects
• Bowel or bladder function

Cervical Spondylolisthesis Treatment

The first line of defense is to modify your activities so as to eliminate harmful movements. A cervical spondylolisthesis brace can be helpful to this end. Physical therapy can also be helpful for teaching the body to move in less harmful ways.

A brace and over-the-counter anti-inflammatory pain medications can help with pain management. You can apply hot or cold packs to your neck region to help alleviate your symptoms. In severe cases, an epidural injection may help bring relief.

As is the case for lumbar spondylolisthesis, treatment typically includes cervical spondylolisthesis exercises and stretches to strengthen the muscles of the neck to reduce pressure on the spine and maintain or improve its range of motion.

If these conservative modes of treatment fail to bring relief, you may have to resort to surgery . This is typically not your first choice due to the risks of permanent nerve or spinal cord damage. Most procedures do have high success rates, however.

Surgical treatment usually involves one or both of the following:

• Lamino-foraminotomy to decompress the spine
• Fusion to stabilize the spine

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• Spondylolisthesis

Spondylolisthesis in the Cervical Spine

Spondylolisthesis occurs when one vertebra slips out of place in the spinal column. It may slip forward, back or press down on the vertebra below, causing pain and pressure in the neck or back. 

If one of the first seven vertebra in your neck (cervical spine) are affected, your doctor may refer to your condition specifically as spondylolisthesis in the cervical spine. 

What is spondylolisthesis?

When one of your vertebrae slips out of place, it can cause the back or neck to gradually bend or the spinal canal to narrow. Some individuals feel pain as soon as the disc slips out of place, but others may not experience any symptoms.

There are many types and causes of spondylolisthesis, including:

• Degenerative spondylolisthesis: As we age, our discs lose water – making it harder for them to hold vertebra in place. This is the most common type of spondylolisthesis.
• Congenital spondylolisthesis: An abnormal arrangement of vertebrae, present since birth, creates a higher risk of slipping out of place.
• Isthmic spondylolisthesis: Small stress fractures in the vertebrae weaken the bone and allow it to slip out of place.
• Traumatic spondylolisthesis: A sudden, serious injury causes a spinal fracture or vertebral to slip out of place. 
• Pathological spondylolisthesis: Certain diseases (such as osteoporosis, tumors or infection) can weaken the spine and increase the risk of slippage.
• Post-surgical spondylolisthesis: Rarely, spinal surgery can cause slippage.

What are symptoms of cervical spondylolisthesis?

Spondylolisthesis that affects the neck generally causes neck pain. Pain often radiates to the shoulder blade or back of the head. The condition may even cause pain and numbness in the arms or legs. 

Serious symptoms also include loss of bladder or bowel control. If you are experiencing a difficult time controlling body functions, contact a back and spine specialist  immediately. 

How is cervical spondylolisthesis treated?

Spondylolisthesis that affects the neck calls for experienced care to help address the cause of the condition and help you manage pain and symptoms. The team at St. Elizabeth Spine Center, and our affiliated surgeons, are committed to providing cutting-edge care that helps you feel whole again. 

Treatment options may include pain management, physical and occupational therapy, steroid injections and surgery.

Pain management

Effective pain management can help you relieve symptoms and enjoy your favorite activities once again. Your doctor will discuss which pain management options are right for you, including over-the-counter or prescription pain relief. 

Therapy 

A physical therapist can help you strengthen your neck and share exercises that help increase your range of motion. A therapist can also help you adapt every day activities – from sleeping, driving and washing dishes – to minimize pain and reduce your symptoms. 

Corticosteroids

Steroid injections, directly in the affected area, can help reduce swelling and relieve pain. Corticosteroids offer temporary relief. Your doctor will discuss if this approach is right for you. 

Do I need surgery for cervical spondylolisthesis?

Physical therapy and a conservative treatment approach can often address the cause and symptoms of cervical spondylolisthesis. If your symptoms and pain do not improve, your doctor may recommend surgery, such as: 

• Microdiscectomy
• Hemilaminectomy
• Anterior cervical discectomy with fusion
• Laminectomy 
• Spinal fusion

How is cervical spondylolisthesis diagnosed?

Cervical spondylolisthesis can be diagnosed with a complete examination and imaging tests, such as X-ray, magnetic resonance imaging (MRI) or computerized tomography (CT) scan. These imaging tests allow your doctor to see if any vertebrae have slipped out of place.

The team at St. Elizabeth includes surgeons and specialists with unmatched experience in diagnosing and treating injuries, conditions and diseases that cause lumbar and sacral spine pain. Physicians and accredited providers offer their insight on how to best treat your back pain. Meet our providers. Call the Spine Center at St. Elizabeth at (859) 212-7000 and get started on the road to recovery. A physician referral may be necessary to make an appointment.  If you need surgery, our experienced affiliated surgeons will map out a plan that’s tailored to your health history, condition and symptoms. Meet our surgeons.

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• Cervical spondylosis

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When to see a doctor, risk factors, complications.

Cervical spondylosis is a general term for age-related wear and tear affecting the spinal disks in your neck. As the disks dehydrate and shrink, signs of osteoarthritis develop, including bony projections along the edges of bones (bone spurs).

Cervical spondylosis is very common and worsens with age. More than 85% of people older than age 60 are affected by cervical spondylosis.

For most people, cervical spondylosis causes no symptoms. When symptoms do occur, nonsurgical treatments often are effective.

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Most people experience no symptoms. When symptoms do occur, they typically include pain and stiffness in the neck.

Sometimes, cervical spondylosis results in a narrowing of the spinal canal within the bones of the spine (the vertebrae). The spinal canal is the space inside the vertebrae that the spinal cord and the nerve roots pass through to reach the rest of the body. If the spinal cord or nerve roots become pinched, you might experience:

• Tingling, numbness and weakness in the arms, hands, legs or feet
• Lack of coordination and difficulty walking
• Loss of bladder or bowel control

Seek medical attention if you notice a sudden onset of numbness or weakness, or loss of bladder or bowel control.

From Mayo Clinic to your inbox

As people age, the structures that make up the backbone and neck gradually develop wear and tear. These changes can include:

• Dehydrated disks. Disks act like cushions between the vertebrae of the spine. By the age of 40, most people's spinal disks begin drying out and shrinking. As the disks become smaller, there is more bone-on-bone contact between the vertebrae.
• Herniated disks. Cracks also appear on the exterior of the spinal disks. The soft interior of a disk can squeeze through these cracks. Sometimes, it presses on the spinal cord and nerve roots.
• Bone spurs. As the disks break down, the body may produce extra amounts of bone in a misguided effort to strengthen the spine. These bone spurs can sometimes pinch the spinal cord and nerve roots.
• Stiff ligaments. Ligaments are cords of tissue that connect bone to bone. Spinal ligaments can stiffen with age, making the neck less flexible.

Cervical spondylosis is the degeneration of the bones and disks in the neck. This condition can lead to a variety of problems, including herniated disks and bone spurs.

Risk factors for cervical spondylosis include:

• Age. Cervical spondylosis occurs commonly as part of aging.
• Occupation. Jobs that involve repetitive neck motions, awkward positioning or a lot of overhead work put extra stress on the neck.
• Neck injuries. Previous neck injuries appear to increase the risk of cervical spondylosis.
• Genetic factors. Some individuals in certain families will experience more of these changes over time.
• Smoking. Smoking has been linked to increased neck pain.

If cervical spondylosis severely compresses your spinal cord or nerve roots, the damage can be permanent.

Nov 18, 2023

• Miller M, et al. Cervical spondylotic myelopathy. In: DeLee, Drez, and Miller's Orthopaedic Sports Medicine: Principles and Practice. 5th ed. Elsevier; 2020. https://www.clinicalkey.com. Accessed April 9, 2022.
• Levin K. Cervical spondylotic myelopathy. https://www.uptodate.com/contents/search. April 9, 2022.
• Isaac Z, et al. Evaluation of the patient with neck pain. https://www.uptodate.com/contents/search. April 8, 2022.
• Kothari M. Clinical features and diagnosis of cervical radiculopathy. https://www.uptodate.com/contents/search. Accessed May 7, 2022.
• Cervical spondylosis (arthritis of the neck). American Academy of Orthopaedic Surgeons. https://orthoinfo.aaos.org/en/diseases--conditions/cervical-spondylosis-arthritis-of-the-neck. Accessed April 9, 2022.
• Ferri FF. Cervical disc syndromes. In: Ferri's Clinical Advisor 2022. Elsevier; 2022. https://www.clinicalkey.com. Accessed April 9, 2022.
• Kothari M. Treatment and prognosis of cervical radiculopathy. https://www.uptodate.com/contents/search. Accessed April 9, 2022.
• Rubin M. Cervical spondylosis and spondylotic cervical myelopathy. Merck Manual Professional Version. https://www.merckmanuals.com/professional/neurologic-disorders/spinal-cord-disorders/cervical-spondylosis-and-spondylotic-cervical-myelopathy. Accessed April 9, 2022.
• Theodore N. Degenerative cervical spondylosis. The New England Journal of Medicine. 2020. doi:10.1056/NEJMra2003558.
• Isaac Z. Management of non-radicular neck pain in adults. https://www.uptodate.com/contents/search. Accessed April 9, 2022.
• Gross A, et al. Manipulation and mobilisation for neck pain contrasted against an inactive control or another active treatment. Cochrane Database of Systematic Reviews. 2015. doi:10.1002/14651858.CD004249.pub4.
• Shelerud RA (expert opinion). Mayo Clinic. April 23, 2022.
• Nahin RL, et al. Evidence-based evaluation of complementary health approaches for pain management in the United States. Mayo Clinic Proceedings. 2016. doi:10.1016/j.mayocp.2016.06.007.
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Spondylolisthesis

Spondylolisthesis is slippage of a lumbar vertebra in relation to the vertebra below it. Anterior slippage (anterolisthesis) is more common than posterior slippage (retrolisthesis). Spondylolisthesis has multiple causes. It can occur anywhere in the spine and is most common in the lumbar and cervical regions. Lumbar spondylolisthesis may be asymptomatic or cause pain when walking or standing for a long time. Treatment is symptomatic and includes physical therapy with lumbar stabilization.

There are five types of spondylolisthesis, categorized based on the etiology:

Type I, congenital: caused by agenesis of superior articular facet

Type II, isthmic: caused by a defect in the pars interarticularis (spondylolysis)

Type III, degenerative: caused by articular degeneration as occurs in conjunction with osteoarthritis

Type IV, traumatic: caused by fracture, dislocation, or other injury

Type V, pathologic: caused by infection, cancer, or other bony abnormalities

Spondylolisthesis usually involves the L3-L4, L4-L5, or most commonly the L5-S1 vertebrae.

Types II (isthmic) and III (degenerative) are the most common.

Type II often occurs in adolescents or young adults who are athletes and who have had only minimal trauma; the cause is a weakening of lumbar posterior elements by a defect in the pars interarticularis (spondylolysis). In most younger patients, the defect results from an overuse injury or stress fracture with the L5 pars being the most common level.

Type III (degenerative) can occur in patients who are > 60 and have  osteoarthritis ; this form is six times more common in women than men.

Anterolisthesis requires bilateral defects for type II spondylolisthesis. For type III (degenerative) there is no defect in the bone.

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Spondylolisthesis is graded according to the percentage of vertebral body length that one vertebra subluxes over the adjacent vertebra:

Grade I: 0 to 25%

Grade II: 25 to 50%

Grade III: 50 to 75%

Grade IV: 75 to 100%

Spondylolisthesis is evident on plain lumbar x-rays. The lateral view is usually used for grading. Flexion and extension views may be done to check for increased angulation or forward movement.

Mild to moderate spondylolisthesis (anterolisthesis of ≤ 50%), particularly in the young, may cause little or no pain. Spondylolisthesis can predispose to later development of foraminal stenosis . Spondylolisthesis is generally stable over time (ie, permanent and limited in degree).

Treatment of spondylolisthesis is usually symptomatic. Physical therapy with lumbar stabilization exercises may be helpful.

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Cervical Spondylosis

Cervical spondylosis is a type of degenerative disease that affects your neck. Normally, soft disks between your vertebrae, the bones in your spine, provide cushioning. With cervical spondylosis, these disks become compressed.

When this happens, the cartilage that lines the vertebrae on each side of the disc, where they touch, can wear away. Once this protective cartilage is gone, spurs may develop on your vertebrae where they rub together. Nerves attached to your spinal cord may have less room to pass between the vertebrae on their way out of the spine.

Facts about cervical spondylosis

This condition becomes more common with age. Many, however, don't have symptoms—you may not even be aware that these changes are going on in your neck.

Cervical spondylosis usually doesn't lead to disability. But sometimes these changes in the spine can cause the spinal cord or nerve roots attached to it to become compressed. This can cause your legs or hands to feel weak or clumsy.

Symptoms of cervical spondylosis can include:

Pain in the neck that may travel to your arms or shoulders

A grinding feeling when you move your neck

Weakness in your arms and legs

Numbness in your shoulders, arms, or hands

Stiffness in the neck

Trouble keeping your balance

Trouble controlling your bladder or bowels

Your healthcare provider will give you a physical examination to see if you have this condition. You will probably discuss any neck injuries you've had and describe your symptoms. The healthcare provider will probably check your neck, shoulders, arms, and legs to see how well they're working. Other tests that may help make a diagnosis include:

Imaging tests. X-rays, MRIs, and CT scans all provide images of the structures in your spine for the healthcare provider to see. These can show the bones, disks, muscles, and nerves in and around your neck, as well as your spinal cord.

Myelography. During this test, the healthcare provider injects a dye into the fluid around your spinal cord and then does a CT scan to see how the bone spurs and disks are interacting with the individual nerves.

Electromyography. This test shows how well your nerves are passing along signals from your spinal cord to your muscles.

Your healthcare provider can recommend a variety of treatments for pain relief from cervical spondylosis, depending on your needs. These may include:

Medicines. Nonsteroidal anti-inflammatory medicines, like ibuprofen or aspirin, opioid pain relievers, and muscle relaxants may help.

Physical therapy. A physical therapist can teach you stretching and strengthening exercises that may ease symptoms.

Ice or heat. Cool your neck with an ice pack or heat it with a warming pad as directed by your healthcare provider or physical therapist.

Collar. Wearing a soft collar around your neck for short periods may help your symptoms. It can cause your neck to weaken, however, if you wear it too long.

Injections. A healthcare provider can inject steroid medicine and pain-relieving drugs into the painful joint in your neck or into the space next to your spinal cord.

Surgery. In most cases, surgery is not needed. But surgeons can do different procedures to relieve pressure on the spinal cord or the nerves leaving your spine, if necessary. A surgeon can remove bone from around the opening that allows the nerve to exit the spine or bone from other parts of the vertebrae. He or she may also fuse bones in the spine after 1 of these procedures. If you have surgery, an anesthesia provider will put you to sleep beforehand so you don't feel it.

You may not be able to prevent cervical spondylosis, but these steps may reduce your risk:

Stay physically active.

Use good posture.

Prevent neck injuries by always using the right equipment and the right form when exercising or playing sports.

Avoid trauma to your neck

Managing cervical spondylosis

Talk with your healthcare provider about the best nonsurgical steps to help relieve your symptoms. The best way to go could possibly be a combination approach of medicine and physical therapy.

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Spondylolisthesis

Spondylolisthesis is where one of the bones in your spine, called a vertebra, slips forward. It can be painful, but there are treatments that can help.

It may happen anywhere along the spine, but is most common in the lower back.

Check if you have spondylolisthesis

The main symptoms of spondylolisthesis include:

• pain in your lower back, often worse when standing or walking and relieved when sitting or bending forward
• pain spreading to your bottom or thighs
• tight hamstrings (the muscles in the back of your thighs)
• pain, numbness or tingling spreading from your lower back down 1 leg ( sciatica )

Spondylolisthesis does not always cause symptoms.

Spondylolisthesis is not the same as a slipped disc . This is when the tissue between the bones in your spine pushes out.

Non-urgent advice: See a GP if:

• you have lower back pain that does not go away after 3 to 4 weeks
• you have pain in your thighs or bottom that does not go away after 3 to 4 weeks
• you're finding it difficult to walk or stand up straight
• you're worried about the pain or you're struggling to cope
• you have pain, numbness and tingling down 1 leg for more than 3 or 4 weeks

What happens at your GP appointment

If you have symptoms of spondylolisthesis, the GP may examine your back.

They may also ask you to lie down and raise 1 leg straight up in the air. This is painful if you have tight hamstrings or sciatica caused by spondylolisthesis.

The GP may arrange an X-ray to see if a bone in your spine has slipped forward.

You may have other scans, such as an MRI scan , if you have pain, numbness or weakness in your legs.

Treatments for spondylolisthesis

Treatments for spondylolisthesis depend on the symptoms you have and how severe they are.

Common treatments include:

• avoiding activities that make symptoms worse, such as bending, lifting, athletics and gymnastics
• taking anti-inflammatory painkillers such as ibuprofen or stronger painkillers on prescription
• steroid injections in your back to relieve pain, numbness and tingling in your leg
• physiotherapy to strengthen and stretch the muscles in your lower back, tummy and legs

The GP may refer you to a physiotherapist, or you can refer yourself in some areas.

Waiting times for physiotherapy on the NHS can be long. You can also get it privately.

Surgery for spondylolisthesis

The GP may refer you to a specialist for back surgery if other treatments do not work.

Types of surgery include:

• spinal fusion – the slipped bone (vertebra) is joined to the bone below with metal rods, screws and a bone graft
• lumbar decompression – a procedure to relieve pressure on the compressed spinal nerves

The operation is done under general anaesthetic , which means you will not be awake.

Recovery from surgery can take several weeks, but if often improves many of the symptoms of spondylolisthesis.

Talk to your surgeon about the risks and benefits of spinal surgery.

Causes of spondylolisthesis

Spondylolisthesis can:

• happen as you get older – the bones of the spine can weaken with age
• run in families
• be caused by a tiny crack in a bone (stress fracture) – this is more common in athletes and gymnasts

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What Is Spondylolisthesis?

Types of spondylolisthesis, frequently asked questions.

Spondylolisthesis is a condition in which a vertebra in the lumbar (lower) spine slips out of normal position, sliding forward (or sometimes backward) relative to the vertebra beneath it. It can be the result of an injury, lower back stress associated with sports, or age-related changes in the spine.

Depending on the extent of movement of the vertebra involved, symptoms can range from none at all to severe pain caused by pressure on a  spinal nerve .

Spondylolisthesis usually is diagnosed with an X-ray . Low-grade spondylolisthesis may be relieved with non-invasive measures, while more severe cases may require a surgical procedure.

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The vertebrae are the box-shaped bones stacked on top of each other that make up the spinal column. Each vertebra should be neatly stacked on the one above and below. The spinal column has a normal S-shaped curvature when viewed from the side, but each vertebra should be neatly positioned on top of the vertebra below.

In spondylolisthesis, the vertebrae shift from their normal position. As a result, the condition is often referred to as "slipped vertebrae." Forward slippage is called anterolisthesis and backward slippage is called retrolisthesis .

Most often, this is a very slowly progressive condition with different types that include:

• Isthmic spondylolisthesis:  This results from spondylolysis, a condition that leads to small stress fractures (breaks) in the vertebrae. In some cases, the fractures weaken the bone so much that it slips out of place.
• Degenerative spondylolisthesis:  Degenerative spondylolisthesis is related to spine changes that tend to occur with age. For example, the discs can start to dry up and become brittle; as this occurs, they shrink and may bulge. Spinal arthritis is another age-related condition. Degenerative spondylolisthesis can cause  spinal stenosis , in which the bones narrow and put pressure on the spinal cord.
• Congenital spondylolisthesis:  Congenital spondylolisthesis results from abnormal bone formation that is present from birth, leaving the vertebrae vulnerable to slipping.

Less common forms of the condition include:

• Traumatic spondylolisthesis:  With this, a spinal fracture or vertebral slipping occurs due to injury.
• Pathological spondylolisthesis:  In this case, spondylolisthesis occurs due to another disease, such as  osteoporosis , a tumor, or an infection.
• Post-surgical spondylolisthesis:  This occurs when spine surgery results in slippage of the vertebrae.

Many people with spondylolisthesis have no obvious symptoms. Sometimes the condition is not discovered until an X-ray is taken for an unrelated injury or condition.

The most common symptom is lower back pain that can radiate to the buttocks and down the backs of the thighs. The symptoms may get worse during activity and subside during rest. Specifically, you may find that symptoms disappear when you bend forward or sit and get worse when you stand or walk.

This is because sitting and bending open up the space where spinal nerves are located, relieving pressure. Other potential symptoms include:

• Muscle spasms
• Tight hamstrings (muscles in the back of the thigh)
• Difficulty walking or standing for a long period of time
• Changes in gait

Severe or high-grade slips may result in pressure on a nearby spinal nerve root, causing tingling, numbness, or weakness in one or both legs.

Children involved in sports such as gymnastics, football, and diving tend to be at an increased risk for isthmic spondylolisthesis. These sports require repeated spinal hyperextension , which can cause a stress fracture of the pars interarticularis in the L5 vertebra.

Unless the hyperextension exercises are stopped to give the bone time to heal, scar tissue can form and prevent the bones from ever healing properly. This can lead to spondylolysis or stress fractures in the pars interarticularis, a condition that commonly leads to spondylolisthesis.

It's possible to be born with spondylolysis or spondylolisthesis, but both conditions can also develop from an injury, a disease, or a tumor.

Genetics may play a role in the risk of spondylolisthesis. There have been higher reports of spondylolisthesis in certain ethnic groups, namely Inuit Eskimos and Black Americans assigned female at birth .

Degenerative spondylolisthesis, the most common type, tends to affect adults over the age of 40. Older age, female gender, being overweight or obese, and conditions that can affect the spine, such as degenerative disc disease (DDD) and osteoarthritis , are thought to be factors that elevate the risk for this condition.

A healthcare professional will first talk to you and/or your child about symptoms, medical history, general health, and any participation in sports or physical activities. Then, they will examine the spine, looking for areas of tenderness or muscle spasms, and assess whether there are problems with gait or posture.

Next, your practitioner may order imaging studies, including:

• X-rays: These help distinguish between spondylolysis and spondylolisthesis. An X-ray taken from the side is also used to assign a grade between I and V, based on the severity of the slippage.
• Computed tomography (CT) scans :  These provide greater detail than X-rays and help a healthcare professional prescribe the most appropriate treatment.
• Magnetic resonance imaging (MRI) scans :  An MRI focuses on the body's soft tissues and can reveal damage to the intervertebral disks between the vertebrae or compression of spinal nerve roots.

There are five spondylolisthesis grades, each representing an incremental 25% increase of slippage in the vertebra.

Spondylolisthesis is treated according to the grade. For grades I and II, conservative treatments are often sufficient, including nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, physical therapy, home exercises, stretching, and the use of a brace.  In physical therapy,  core strengthening and stabilization  exercises are emphasized.

Over the course of treatment, periodic X-rays may be taken to determine whether the vertebra is changing position.

For high grades or progressive worsening,  spinal fusion surgery  may be recommended. During this procedure, the affected vertebrae are fused together so that they heal into a single, solid bone.

During the procedure, the surgeon will realign the vertebrae in the lumbar spine. Small pieces of bone—called a bone graft—are then placed into the spaces between the vertebrae to be fused. Over time, the bones grow together, much like when a broken bone heals. Metal screws and rods may be installed to further stabilize the spine and improve the chances of successful fusion.

In some cases, patients with high-grade slippage also have compression of the spinal nerve roots. If this is the case, a procedure known as spinal decompression can help open up the spinal canal and relieve pressure on the nerves.

Spondylolisthesis is a spine condition in which a vertebra slips out of position. This may cause symptoms like low back pain and back stiffness. Young athletes are often at increased risk for spondylolisthesis as overextending the spine—which commonly happens in sports like football and gymnastics—is one of the most common causes of the condition.

To diagnose spondylolisthesis, a healthcare professional will review a person's symptoms and medical history, and they'll use imaging tests like X-rays and CT scans to analyze the spine and determine the severity, or grade, of the problem.

Lower-grade cases of spondylolisthesis typically respond well to conservative treatment like anti-inflammatory medication and physical therapy, while higher-grade cases may require surgery.

In most cases, it's possible to resume activities, including sports, once the condition has been treated. If symptoms reappear after treatment, tell a healthcare provider so that they can determine what strategies are needed to relieve them and restore your quality of life.

Spondylosis is a condition in which there is a stress fracture or weakness in a vertebra. Spondylolisthesis occurs when a vertebra slips out of position. Spondylosis may lead to spondylolisthesis, as a fracture in a vertebra may cause it to slip.

If you have spondylolisthesis, you may qualify for disability insurance if symptoms are severe and greatly impact your quality of life.

Those with spondylolisthesis should avoid movements that put great stress on the spine, such as lifting heavy objects. They should also avoid participating in sports that can lead to overtwisting or overextending the spine, like gymnastics and wrestling, until after treatment.

Cleveland Clinic. Spondylolisthesis .

Cedars Sinai. Spondylolisthesis .

American Academy of Orthopaedic Surgeons.  Spondylolysis and spondylolisthesis .

NYU Langone Health. Diagnosing spondylolisthesis in adults .

Wang YXJ, Káplár Z, Deng M, Leung JCS. Lumbar degenerative spondylolisthesis epidemiology: A systematic review with a focus on gender-specific and age-specific prevalence . J Orthop Translat . 2016;11:39-52. doi:10.1016/j.jot.2016.11.001

Tedyanto EH. Relationship between body mass index and radiological features of spondylolisthesis . International Journal of Science and Research. 2020;9(2):2319-7064. doi:10.21275/SR20215210921

Koslosky E, Gendelberg D. Classification in brief: The Meyerding classification system of spondylolisthesis . Clin Orthop Relat Res . 2020;478(5):1125-1130. doi:10.1097/CORR.0000000000001153

American Academy of Orthopaedic Surgeons. Spinal fusion .

Cleveland Clinic. Spondylolysis .

By Jonathan Cluett, MD Dr. Cluett is board-certified in orthopedic surgery. He served as assistant team physician to Chivas USA (Major League Soccer) and the U.S. national soccer teams.

Spondylolisthesis: Definition, Causes, Symptoms, and Treatment

by Dave Harrison, MD • Last updated November 26, 2022

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What is Spondylolisthesis?

The spine is comprised of 33 bones, called vertebra , stacked on top of each other interspaced by discs . Spondylolisthesis is a condition where one vertebra slips forward or backwards relative to the vertebra below. More specifically, retrolisthesis is when the vertebra slips posteriorly or backwards, and anterolisthesis is when the vertebra slips anteriorly or forward.

Spondylosis vs Spondylolisthesis

Spondylosis and Spondylolisthesis are different conditions. They can be related but are not the same. Spondylosis refers to a fracture of a small bone, called the pars interarticularis, which connects the facet joint of the vertebra to the one below. This may lead to instability and ultimately slippage of the vertebra. Spondylolisthesis, on the other hand, refers to slippage of the vertebra in relation to the one below.

Types and Causes of Spondylolisthesis

There are several types of spondylolisthesis, often classified by their underlying cause:

Degenerative Spondylolisthesis

Degenerative spondylolisthesis is the most common cause, and is due to general wear and tear on the spine. Overtime, the bones and ligaments which hold the spine together may become weak and unstable.

Isthmic Spondylolisthesis

Isthmic spondylolisthesis is the result of another condition, called “ spondylosis “. Spondylosis refers to a fracture of a small bone, called the pars interarticularis, which connects the facet joint of the vertebra to the one below. If this interconnecting bone is broken, it can lead to slippage of the vertebra. This can sometimes occur during childhood or adolsence but go unnoticed until adulthood when degenerative changes cause worsening slippage.

Congenital Spondylolisthesis

Congenital spondylolisthesis occurs when the bones do not form correctly during fetal development

Traumatic Spondylolisthesis

Traumatic spondylolisthesis is the result of an injury such as a motor vehicle crash

Pathologic Spondyloslisthesis

Pathologic spondylolisthesis is when other disorders weaken the points of attachment in the spine. This includes osteoporosis, tumors, or infection that affect the bones and ligaments causing them to slip.

Iatrogenic Spondylolisthesis

Iatrogenic spondylolisthesis is the result of a prior surgery. Some operations of the spine, such as a laminectomy, may lead to instability. This can cause the vertebra to slip post operatively.

Spondylolisthesis Grades

Spondylolisthesis is classified based on the degree of slippage relative to the vertebra below

• Grade 1 : 1 – 25 % forward slip. This degree of slippage is usually asymptomatic.
• Grade 2: 26 – 50 % forward slip. May cause mild symptoms such as stiffness and pain in your lower back after physical activity, but it’s not severe enough to affect your everyday activities.
• Grade 3 : 51 – 75 % forward slip. May cause moderate symptoms such as pain after physical activity or sitting for long periods.
• Grade 4: 76 – 99% forward slip. May cause moderate to severe symptoms.
• Grade 5: Is when the vertebra has slipped completely of the spinal column. This is a severe condition known as “spondyloptysis”.

Symptoms of Spondylolisthesis

Spondylolisthesis can cause compression of spinal nerves and in severe cases, the spinal cord. The symptoms will depend on which vertebra is affected.

Cervical Spondylolisthesis (neck)

• Arm numbness or tingling
• Arm weakness

Lumbar Spondylolisthesis (low back)

• Buttock pain
• Leg numbness or tingling
• Leg weakness

Diagnosing Spondylolisthesis

Your doctor may order imaging tests to confirm the diagnosis and determine the severity of your spondylolisthesis. The most common imaging tests used include:

• X-rays : X-rays can show the alignment of the vertebrae and any signs of slippage.
• CT scan: A CT scan can provide detailed images of the bones and soft tissues in your back, allowing your doctor to see any damage or abnormalities.
• MRI: An MRI can show the spinal cord and nerves, as well as any herniated discs or other soft tissue abnormalities.

Treatments for Spondylolisthesis

Medications.

For those experiencing pain, oral medications are first line treatments. This includes non-steroidal anti-inflammatory medications (NSAIDs) such as ibuprofen, acetaminophen, or in severe cases opioids or muscle relaxants (with extreme caution). Topical medications such as lidocaine patches are also sometimes used.

Physical Therapy

Physical therapy can help improve mobility and strengthen muscles around your spine to stabilize your neck and lower back. You may also receive stretching exercises to improve flexibility and balance exercises to improve coordination.

Surgery is reserved for severe cases of spondylolisthesis in which there is a high degree of instability and symptoms of nerve compression.

In these cases a spinal fusion may be necessary. This surgery joins two or more vertebra together using rods and screws, in order to improve stability.

Reference s

• Alfieri A, Gazzeri R, Prell J, Röllinghoff M. The current management of lumbar spondylolisthesis. J Neurosurg Sci. 2013 Jun;57(2):103-13. PMID: 23676859.
• Stillerman CB, Schneider JH, Gruen JP. Evaluation and management of spondylolysis and spondylolisthesis. Clin Neurosurg. 1993;40:384-415. PMID: 8111991.

About the Author

Dave Harrison, MD

Dr. Harrison is a board certified Emergency Physician with a part time appointment at San Francisco General Medical Center and is an Assistant Clinical Professor-Volunteer at the UCSF School of Medicine. Dr. Harrison attended medical school at Tufts University and completed his Emergency Medicine residency at the University of Southern California. Dr. Harrison manages the editorial process for SpineInfo.com.

OHSU Spine Center

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Spine Center

Spondylolisthesis.

In spondylolisthesis, one of your spinal bones (vertebrae) slides forward over the bone below it. It’s most common in the lumbar spine (lower back) but can also occur in the cervical spine (neck). The sliding bone can press on the spinal cord or nerves, causing pain, weakness and other symptoms. Timely treatment is important because spondylolisthesis can worsen over time.

Spondylolisthesis is caused by changes in the spine’s facet joints. These small joints are linked, keeping the vertebrae aligned while allowing the spine to move. The spinal discs help cushion the joints.

With age, the discs can flatten, allowing the facet joints to break down or slide out of place. When the vertebrae move forward slightly, this is called degenerative spondylolisthesis or pseudo-spondylolisthesis.

Bone defects can also cause spondylolisthesis. The bones that connect the facet joints are prone to stress fractures in some people, letting the vertebrae slip out of place.

Symptoms can come on suddenly. They tend to get better with rest, though they might not go away completely.

• Low-back or neck pain
• Pain that radiates down the arms or legs
• Pain that gets worse with exercise
• Hamstring (back thigh) tightness
• Neck stiffness
• Loss of spine flexibility
• Pain, numbness, tingling or weakness in the arms, hands, legs or feet
• Muscle spasms in the back or neck

Nonsurgical treatments

The OHSU Spine Center favors noninvasive treatments for spondylolisthesis whenever possible.

• Physical therapy : Exercises to strengthen your neck, trunk and abdominal muscles and to increase spine flexibility can help.
• Bracing : Wearing a brace can help if you have muscle spasms.
• Medication : Nonsteroidal anti-inflammatory medication can help.

Surgical treatment

Surgery may be recommended if you have severe symptoms, if the vertebrae have slid far out of place, or if other treatments didn’t help.

• Spinal fusion surgery : This surgery permanently joins two or more bones (vertebrae) and is used in spondylolisthesis to keep bones from moving.

Degenerative spondylolisthesis of the cervical spine--symptoms and surgical strategies depending on disease progress

Affiliation.

• 1 Department of Neurosurgery, Charité-Campus Virchow-Klinikum, University Medicine of Berlin, 13444, Berlin, Germany. [email protected]
• PMID: 15221569
• PMCID: PMC3454058
• DOI: 10.1007/s00586-004-0673-9

Background: Degenerative spondylolisthesis of the cervical spine is rare. Patients show signs of progredient myelopathy, radiculopathy and pain. Treatment strategies include ventral, dorsal and combined fusion techniques with or without repositioning and decompression.

Methods: In this study, we present 16 patients with degenerative cervical spondylolisthesis. The leading symptom was severe myelopathy in 8 patients, radiculomyelopathy in 5 patients and neck pain in 3 patients. However, neck pain was the initial symptom in all the patients and decreased when neurological symptoms became more evident. Radiographic examinations included plain radiography, MRI, CT, myelography and lateral tomography.

Results: Spondylolisthesis was located five times at level C3/4, C4/5 and C5/6. In three cases spondylolisthesis was located at level C7/T1. There were two patients with spondylolisthesis on two levels. Instability could be demonstrated by flexion/extension radiography in five cases. Patients were divided into three groups according to a newly introduced classification system. The surgical approach corresponded to this classification. In ten patients the spondylolisthesis could be corrected by extension and positioning, so discectomy and fusion on one or two levels with cage, plate and screws was sufficient. In five cases a corpectomy was necessary due to severe spondylosis. In one case a combined approach with dorsal decompression and release followed by ventral fusion was applied due to additional dorsal spinal cord compression. The follow-up period was 6-52 months. After surgery, none of the patients showed any signs of neurological deterioration. In all cases, a stable fusion was achieved with no signs of instability on flexion/extension radiographs. Neurological improvement was seen in 6 of 8 patients with myelopathy and 4 of 5 patients with radiculomyelopathy. The others showed stable disease. Pain relief was seen in all patients who complained of pain preoperatively.

Conclusion: The aims of treatment for cervical spondylolisthesis are spinal cord decompression (ventral, dorsal or both), correction and fusion. The used procedure should depend on the severity of the cervical deformity, degree and side of the spinal cord compression, and the possibility of correction by extension and positioning.

• Cervical Vertebrae / diagnostic imaging
• Cervical Vertebrae / pathology
• Cervical Vertebrae / surgery*
• Decompression, Surgical / methods*
• Decompression, Surgical / standards
• Decompression, Surgical / statistics & numerical data
• Disease Progression
• Internal Fixators / standards
• Internal Fixators / statistics & numerical data
• Internal Fixators / trends
• Magnetic Resonance Imaging
• Middle Aged
• Neck Pain / etiology
• Neck Pain / physiopathology
• Neck Pain / surgery
• Postoperative Complications
• Radiculopathy / etiology
• Radiculopathy / physiopathology
• Radiculopathy / surgery
• Retrospective Studies
• Spinal Cord Compression / etiology
• Spinal Cord Compression / physiopathology
• Spinal Cord Compression / surgery*
• Spinal Fusion / methods*
• Spinal Fusion / standards
• Spinal Fusion / statistics & numerical data
• Spondylolisthesis / pathology
• Spondylolisthesis / physiopathology
• Spondylolisthesis / surgery*
• Tomography, X-Ray Computed
• Treatment Outcome