spondylolisthesis symptoms and signs

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.

Spondylolisthesis

• Diagnosis |
• Treatment |

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 degeneration of the discs between the vertebrae or 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

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 .)

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Spondylolisthesis

Spondylolisthesis is a displacement of a vertebra in which the bone slides out of its proper position onto the bone below it. Most often, this displacement occurs following a break or fracture.

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

Other complications may include:

• Chronic back pain
• Sensation changes
• Weakness of the legs
• Temporary or permanent damage of spinal nerve roots
• Loss of bladder control

When a vertebra slips out of proper alignment, discs can be damaged. To surgically correct this condition, a spinal surgeon removes the damaged disc. The slipped vertebra is then brought back into line, relieving pressure on the spinal nerve.

Types of spondylolisthesis include:

• Dysplastic spondylolisthesis , caused by a defect in part of the vertebra
• Isthmic spondylolisthesis , may be caused by repetitive trauma and is more common in athletes exposed to hyperextension motions
• Degenerative spondylolisthesis , occurs with cartilage degeneration because of arthritic changes in the joints
• Traumatic spondylolisthesis , caused by a fracture of the pedicle, lamina or facet joints as a result of direct trauma or injury to the vertebrae
• Pathologic spondylolisthesis , caused by a bone defect or abnormality, such as a tumor

Symptoms may vary from mild to severe. In some cases, there may be no symptoms at all.

Spondylolisthesis can lead to increased lordosis (also called swayback), and in later stages may result in kyphosis, or round back, as the upper spine falls off the lower.

Symptoms may include:

• Lower back pain
• Muscle tightness (tight hamstring muscle)
• Pain, numbness or tingling in the thighs and buttocks
• Tenderness in the area of the vertebra that is out of place
• Weakness in the legs
• Stiffness, causing changes in posture and gait
• A semi-kyphotic posture (leaning forward)
• A waddling gate in advanced cases
• Lower-back pain along the sciatic nerve
• Changes in bladder function

Spondylolisthesis may also produce a slipping sensation when moving into an upright position and pain when sitting and trying to stand.

Spondylolisthesis may appear in children as the result of a birth defect or sudden injury, typically occurring between the fifth bone in the lower back (lumbar vertebra) and the first bone in the sacrum (pelvis).

In adults, spondylolisthesis is the result of abnormal wear on the cartilage and bones from conditions such as arthritis , trauma from an accident or injury, or the result of a fracture, tumor or bone abnormality.

Sports that place a great deal of stress on bones may cause additional deterioration, fractures and bone disease, which may cause the bones of the spine to become weak and shift out of place.

A simple X-ray of the back will show any cracks, fractures or vertebrae slippage that are the signs of spondylolisthesis.

A CT scan or an MRI may be used to further diagnose the extent of the damage and possible treatments.

Treatment for spondylolisthesis will depend on the severity of the vertebra shift. Stretching and exercise may improve some cases as back muscles strengthen.

Non-invasive treatments include:

• Heat/Ice application
• Pain medicine (Tylenol and/or NSAIDS)
• Physical therapy
• Epidural injections

Surgery may be needed to fuse the shifted vertebrae if the patient has:

• Severe pain that does not get better with treatment
• A severe shift of a spine bone
• Weakness of muscles in a leg or both legs

Surgical process realigns the vertebrae, fixing them in place with a small rod that is attached with a pedicle screw, adding stability to the spine with or without the addition to an interbody (bone graft or cage) placed between the vertebra from the side or front.

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• Spondylolisthesis: Signs You Have It and How to Treat It

Learn more about what causes spondylolisthesis and how to treat it with tips and exercises from physical therapists.

• Hinge Health Learning Center

Table of Contents

Spondylolisthesis (pronounced spaan-duh-low-luhs-thee-suhs ) is a mouthful that sounds pretty serious, but this somewhat common cause of low back pain isn’t as complicated as it seems. It essentially means instability in the spine, and anyone from a young athlete to an older adult with osteoarthritis has the potential to develop it. 

Fortunately, most of the time, symptoms associated with spondylolisthesis aren't hard to treat, as conservative methods including physical therapy usually help a lot , says Mary Kimbrough, PT, DPT, a physical therapist at Hinge Health. 

Read on to learn about what causes spondylolisthesis and how to get relief with help from our Hinge Health physical therapists.

Our Hinge Health Experts

Mary kimbrough, pt, dpt, jonathan lee, md, mba, maureen lu, pt, dpt, what is spondylolisthesis.

Spondylolisthesis results when one of the vertebrae in the spine (“spondy” refers to spine) shifts its position (“listhesis” means slippage). Spondylolisthesis can affect any vertebrae along the spine , but it's most common in the lumbar spine (low back). 

You may have heard of other similar conditions, like spondylosis (osteoarthritis of the spine) or spondyloarthritis (inflammatory arthritis of the spine). In the case of spondylolisthesis , instability is the main problem.

“Spondylolisthesis can simply be part of natural changes in the spine, but it also can be the result of a change or fracture in the pars interarticularis, which is a small piece of bone that links each vertebra to the vertebra beneath it,” Dr. Kimbrough explains. “If it gets fractured or otherwise disrupted, the vertebra can slip forward and out of alignment.” 

This displacement isn’t always painful. If a vertebra has shifted only slightly, you might not even know it. If the affected vertebra irritates nearby nerves, however, it can lead to back pain that may also radiate down the legs.  

Spondylolisthesis: A Hinge Health Perspective

Learning about conditions that cause pain can be scary, and the prospect of hearing that any of your vertebrae have moved position can be understandably alarming. But we know from Hinge Health members and research studies that anatomical labels can backfire when it comes to your treatment and recovery. When people hear they may have a condition like spondylolisthesis, it can cause feelings of panic, like you have something "wrong" that needs to be fixed. This way of thinking about pain is largely outdated.

For most common musculoskeletal conditions, regardless of what may or may not be contributing to pain, the solution is often the same. Movement — through physical and exercise therapy — can build strength, flexibility, and resilience to pain in and around the spine. 

Tap into pain relief. Anytime, anywhere with our app.

Dr. Kimbrough notes that the only way to definitively diagnose this problem is to have an imaging test, like an X-ray, but this kind of workup is not always essential. Physical therapists can usually help based on symptoms as well as information about what preceded the discomfort. Research has shown that the overwhelming majority of patients with mild spondylolisthesis — about 84% — improve with conservative care like physical therapy.

You can see a physical therapist in person or use a program like Hinge Health to access a PT via telehealth/video visit.

Symptoms of Spondylolisthesis

Spondylolisthesis symptoms can vary depending on the severity and location of the affected vertebra. For some people, the condition doesn’t cause any pain. If you do experience symptoms, they’ll often include: 

Low back pain that’s worse when standing or walking for long periods of time (versus sitting)

Stiffness in the low back

Tight hamstrings (muscles behind your thighs); you may also notice spasms

Pain, numbness, or tingling that goes from your lower back down one leg (if the shift impacts a nerve and causes sciatica )

Causes of Spondylolisthesis

Spondylolisthesis is rarely the result of just one cause and is often due to a combination of factors, including:

Sports-related injuries . “Some cases of spondylolisthesis stem from back injuries related to sports, particularly those that involve a lot of hyperextension of the spine,” says Dr. Kimbrough. Gymnastics and weight lifting are common culprits. So is football and wrestling (falling on your stomach can also cause vertebrae to slip forward).

Trauma , like a car accident or a fall . Injury to the spine, such as fractures or stress fractures, can cause instability and contribute to spondylolisthesis.

Genetics . Some people may be born with slight variations in the structure of their spine , such as defective facet joints or elongated pars interarticularis (part of the vertebra). This can make some more likely to develop spondylolisthesis in the future. 

Age-related changes. Osteoarthritis and other age-related changes to the spine may lead to spondylolisthesis.

No matter why spondylolisthesis develops, there’s a lot you can do to manage the symptoms.

Treatment Options for Spondylolisthesis Symptoms

Spondylolisthesis ranges from low grade (mild) to severe (high grade), depending on how far the alignment of a vertebra has shifted. Most mild to moderate cases respond to conservative treatment, says Dr. Kimbrough. Treatment options include:

Activity modification . It’s generally wise to keep moving as much as possible, says Dr. Kimbrough, but you may have to temporarily pull back on pain-provoking activities. Limit back-bending motions (especially extension), high-impact activities, and heavy lifting until the pain subsides.

Ice or heat . Both hot and cold therapy can help you manage lower back pain resulting from spondylolisthesis. Applying ice can help reduce swelling and inflammation, while a hot compress can help relax tense muscles near the affected vertebrae. Whichever feels best and most soothing to you is fine, says Dr. Kimbrough.

Over-the-counter pain medication . Pain relievers such as ibuprofen (Advil, Motrin), naproxen (Aleve), and acetaminophen (Tylenol) can be helpful for pain related to spondylolisthesis. It’s important to make sure that you are safely able to take these medications, based on your medical history.

Bracing . “I don’t often recommend bracing for this problem, but some patients might benefit from temporarily wearing a brace that goes around their waist at the lower part of the spine,” says Dr. Kimbrough. “It might give you a little support and decrease symptoms.” This may also help you feel strong and stable enough to move with confidence. But remember to exercise without the brace as well to help build strength along your back and spine.

Physical therapy . Physical therapy for spondylolisthesis aims to stretch and strengthen surrounding muscles, including those in the hamstrings , hip flexors , and core muscles that wrap around your front and back. Most patients with mild to moderate slippage of vertebrae will benefit from a physical therapy program, says Dr. Kimbrough.

Surgery . If conservative treatments including physical therapy don’t help, or if your vertebrae have shifted significantly (high-grade spondylolisthesis), then surgery may be recommended. Surgery for spondylolisthesis typically entails spinal fusion , during which two vertebrae are joined together to increase stability.

PT-Recommended Exercises for Spondylolisthesis

• Pelvic Tilts
• Bent Hollow Hold
• Kneeling Hip Flexor Stretch

Any physical activity can be helpful for spondylolisthesis, but a physical therapist can suggest movements that target the spine and surrounding muscles to improve flexibility, promote spinal stability, and alleviate symptoms while also aiding in preventing further changes to the spine. The following exercises, often recommended by Hinge Health therapists, are a great place to start.

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

PT Tip: Stretch it Out

Spondylolisthesis often makes standing and walking for long periods uncomfortable, but taking a break to stretch your back can help a lot, says Dr. Kimbrough. “Simply bending forward can take some pressure off your back and provide relief,” she says. Just bend down toward your toes (touch them if you can) and hold for a few seconds. 

How Hinge Health Can Help You

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you.

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here . This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

Looking for pain relief? Check if your employer or health plan covers our program

Spondylolisthesis Symptoms, Diagnosis, and Treatments . (n.d.). Precision Brain, Spine & Pain Centre. Retrieved from https://www.precisionhealth.com.au/healthcare-services/pain-management/conditions-treated/spinal-conditions/spondylolisthesis/  

Pars Defect. (n.d.). Spines Dorset. Retrieved from https://spinesdorset.com/conditions/pars_defect  

Spondylolisthesis . (n.d.). Cedars-Sinai. Retrieved from https://www.cedars-sinai.org/health-library/diseases-and-conditions/s/spondylolisthesis.html  

Klein, G., Mehlman, C. T., & McCarty, M. (2009). Nonoperative Treatment of Spondylolysis and Grade I Spondylolisthesis in Children and Young Adults. Journal of Pediatric Orthopaedics, 29 (2), 146–156. doi:10.1097/bpo.0b013e3181977fc5

Spondylolisthesis Treatment, Surgery & Symptoms . (2020, August 7). Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/10302-spondylolisthesis  

Spondylolisthesis . (2022, January). Kidshealth.org. https://kidshealth.org/en/parents/spondylolisthesis.html  

Surgery for Spondylolisthesis . (n.d.). NYU Langone Health. https://nyulangone.org/conditions/spondylolisthesis/treatments/surgery-for-spondylolisthesis  

Related Articles

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

Page last reviewed: 01 June 2022 Next review due: 01 June 2025

• Degenerative Spondylolisthesis Symptoms

By: Marco Funiciello, DO, Physiatrist

Peer-Reviewed

Degenerative spondylolisthesis typically causes low back pain along with a cluster of symptoms and signs in one or both legs.

Degenerative Spondylolisthesis: Common Symptoms and Signs

Degenerative spondylolisthesis symptoms include neurogenic claudication, sciatica, and radiculopathy.

In degenerative spondylolisthesis, the degenerated facet joints and other parts of the vertebral bone tend to increase in size. The enlarged, abnormal bone then encroaches upon the central canal and/or nerve hole (foramen) causing spinal stenosis or foraminal stenosis.

In This Article:

• Degenerative Spondylolisthesis
• Degenerative Spondylolisthesis Treatment
• Surgery for Degenerative Spondylolisthesis

Degenerative Spondylolisthesis Video

These changes typically result in some combination of the following symptoms and signs.

Persistent low back pain

Low back pain caused by degenerative spondylolisthesis is usually persistent and described as a consistent dull ache, 1 Cushnie D, Johnstone R, Urquhart JC, Gurr KR, Bailey SI, Bailey CS. Quality of Life and Slip Progression in Degenerative Spondylolisthesis Treated Nonoperatively. Spine (Phila Pa 1976). 2018;43(10):E574-E579. doi:10.1097/BRS.0000000000002429 but it may also feel like a sharp, stabbing sensation for some individuals.

The pain is typically localized in the low back region and may worsen with physical activity, standing, or walking.

Neurogenic claudication

Intermittent neurogenic claudication affects around 75% of people with degenerative spondylolisthesis. It is characterized by episodes of low back pain that radiate to both legs, along with accompanying sensations of tingling, a sensation of weakness, and hamstring spasm. 2 Li N, Scofield J, Mangham P, Cooper J, Sherman W, Kaye A. Spondylolisthesis. Orthop Rev (Pavia). 2022 Jul 27;14(4):36917. doi: 10.52965/001c.36917. PMID: 35910544; PMCID: PMC9329062. , 3 García-Ramos CL, Valenzuela-González J, Baeza-Álvarez VB, Rosales-Olivarez LM, Alpizar-Aguirre A, Reyes-Sánchez A. Degenerative spondylolisthesis I: general principles. Espondilolistesis degenerativa lumbar I: principios generales. Acta Ortop Mex. 2020;34(5):324-328.. , 4 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. Published 2016 Dec 1. doi:10.1016/j.jot.2016.11.001

It is possible to have any combination of symptoms and they typically occur during walking variable distances or prolonged standing. 2 Li N, Scofield J, Mangham P, Cooper J, Sherman W, Kaye A. Spondylolisthesis. Orthop Rev (Pavia). 2022 Jul 27;14(4):36917. doi: 10.52965/001c.36917. PMID: 35910544; PMCID: PMC9329062.

Sciatica: Radiating leg pain

Back pain may radiate into the buttock, thighs, and into the leg and foot. 4 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. Published 2016 Dec 1. doi:10.1016/j.jot.2016.11.001

Radiating leg pain is commonly known as sciatica . This pain occurs due to the irritation, compression, or inflammation of spinal nerve roots in the lower back. 4 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. Published 2016 Dec 1. doi:10.1016/j.jot.2016.11.001

Radiculopathy: Abnormal sensations, weakness, and loss of muscle reflexes

When the spinal nerve roots are compressed or sufficiently inflamed and neurologic deficits are present, the condition is called radiculopathy . Radiculopathy may cause leg weakness and affect muscle reflexes. Additionally, numbness may be felt in the thigh, leg, and/or foot. 4 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. Published 2016 Dec 1. doi:10.1016/j.jot.2016.11.001

It may be challenging to perform activities that require strength, such as walking, climbing stairs, or lifting objects.

Little Known Symptoms of Degenerative Spondylolisthesis

As degenerative spondylolisthesis progresses, the symptoms may lessen due to compensatory mechanisms of the spine that increase spinal stability and prevent further progression.

However, in some individuals, the progression may continue and cause the following symptoms and signs.

Sleep disturbances 

Back pain and leg pain may cause disturbed sleep or trouble falling asleep. 5 Kalichman L, Hunter DJ. Diagnosis and conservative management of degenerative lumbar spondylolisthesis. Eur Spine J. 2008;17(3):327-335. doi:10.1007/s00586-007-0543-3

For this reason, some individuals may choose to sleep in the fetal position (sleeping on the side with knees bent close to the chest) to relieve leg symptoms. 5 Kalichman L, Hunter DJ. Diagnosis and conservative management of degenerative lumbar spondylolisthesis. Eur Spine J. 2008;17(3):327-335. doi:10.1007/s00586-007-0543-3

Restless leg syndrome

Leg pain and claudication may sometimes cause restless legs syndrome. In this condition, aching or burning pain in the calves causes an irresistible urge to move the legs continuously, causing disturbed sleep. 5 Kalichman L, Hunter DJ. Diagnosis and conservative management of degenerative lumbar spondylolisthesis. Eur Spine J. 2008;17(3):327-335. doi:10.1007/s00586-007-0543-3

Difficulty walking and imbalance

Degenerative spondylolisthesis may cause difficulty walking and maintaining balance.

As degenerative spondylolisthesis progresses, difficulties with walking and maintaining balance may be experienced. These signs arise from nerve compression caused by the slipped vertebra and associated degenerative changes,  Altered posture, muscle weakness and reduced coordination may result. 6 Studnicka K, Ampat G. Lumbosacral Spondylolisthesis. [Updated 2022 Sep 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560679/

There are many nerves in our legs that are responsible for relaying information to the brain about position and balance. If these nerves are irritated or compressed in the spine then the brain may not get the necessary information needed for good balance and posture control. 

These changes can impact mobility and function, making it harder to engage in normal daily activities.

Limited range of motion

Degenerative spondylolisthesis can affect lumbar range of motion due to the degenerative bone changes that prevent full segmental motion. Muscle spasm and stiffness may result. 

Individuals may find it challenging to twist or engage in activities that involve spinal movement. This restricted range of motion can contribute to discomfort and stiffness in the affected area.

Menopause-Related Spondylolisthesis Symptoms

The onset of menopause may accelerate normal degenerative changes of the lumbar vertebrae, discs, facet joints, and ligaments. 4 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. Published 2016 Dec 1. doi:10.1016/j.jot.2016.11.001

Typically, the symptoms associated with this progression include low back pain, stiffness, and/or pain radiating down the leg (sciatica). 4 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. Published 2016 Dec 1. doi:10.1016/j.jot.2016.11.001

Read more about Sciatica Symptoms

Diagnosis of Degenerative Spondylolisthesis

Radiating sciatica pain may occur in degenerative spondylolisthesis.

A physician trained in musculoskeletal conditions can help diagnose degenerative spondylolisthesis.

A comprehensive assessment of the patient’s history, past medical history, thorough physical examination, and review of any prior tests and imaging studies are performed.

During the review of patient history and the physical examination, physicians typically check for 7 Akkawi I, Zmerly H. Degenerative Spondylolisthesis: A Narrative Review. Acta Biomed. 2022;92(6):e2021313. Published 2022 Jan 19. doi:10.23750/abm.v92i6.10526 :

• Pain pattern. Physicians ask about localized or radiating pain and the pattern of pain distribution to check if sciatica is present.
• Postural effects. In degenerative spondylolisthesis, pain is exacerbated while bending backward and relieved when bending forward.
• History of symptoms. Neurogenic claudication and hamstring spasm while walking or standing for variable periods of time may indicate spinal stenosis caused by degenerative spondylolisthesis.

If these symptoms and signs are noticed, the physician may order imaging tests to further investigate the condition.

Imaging Tests for Degenerative Spondylolisthesis

X-rays are helpful in diagnosing and assessing the extent of degenerative spondylolisthesis.

Imaging tests may help confirm the diagnosis of degenerative spondylolisthesis and provide evidence of the extent of progression of the condition. 

• Standing lateral radiographs are considered the most reliable and standard test for diagnosing degenerative spondylolisthesis. 7 Akkawi I, Zmerly H. Degenerative Spondylolisthesis: A Narrative Review. Acta Biomed. 2022;92(6):e2021313. Published 2022 Jan 19. doi:10.23750/abm.v92i6.10526
• Flexion-extension radiographs are used to determine if there is any motion of one vertebra upon the other (translation) and/or instability during spinal movements. 7 Akkawi I, Zmerly H. Degenerative Spondylolisthesis: A Narrative Review. Acta Biomed. 2022;92(6):e2021313. Published 2022 Jan 19. doi:10.23750/abm.v92i6.10526
• Magnetic resonance imaging (MRI) scans may be used to check for spinal stenosis, nerve root compression, spinal cord involvement, and disc degeneration. 3 García-Ramos CL, Valenzuela-González J, Baeza-Álvarez VB, Rosales-Olivarez LM, Alpizar-Aguirre A, Reyes-Sánchez A. Degenerative spondylolisthesis I: general principles. Espondilolistesis degenerativa lumbar I: principios generales. Acta Ortop Mex. 2020;34(5):324-328.. , 7 Akkawi I, Zmerly H. Degenerative Spondylolisthesis: A Narrative Review. Acta Biomed. 2022;92(6):e2021313. Published 2022 Jan 19. doi:10.23750/abm.v92i6.10526  Some researchers consider MRI scans as the most reliable test to diagnose spinal stenosis in degenerative lumbar spondylolisthesis. 8 Matz PG, Meagher RJ, Lamer T, et al. North American Spine Society. Clinical Guidelines for Multidisciplinary Spine Care. Diagnosis and Treatment of Degenerative Lumbar Spondylolisthesis. 2nd ed.; 2016.
• CT scans are used if bone involvement such as spondylolysis or isthmic spondylolisthesis is suspected, as these scans provide detailed evaluation of bone integrity.

If an MRI is not possible, computed tomography (CT) scans with myelography may be used as an alternative test. 7 Akkawi I, Zmerly H. Degenerative Spondylolisthesis: A Narrative Review. Acta Biomed. 2022;92(6):e2021313. Published 2022 Jan 19. doi:10.23750/abm.v92i6.10526 , 8 Matz PG, Meagher RJ, Lamer T, et al. North American Spine Society. Clinical Guidelines for Multidisciplinary Spine Care. Diagnosis and Treatment of Degenerative Lumbar Spondylolisthesis. 2nd ed.; 2016.

MRI scans or CT scans may also be used if severe neurogenic claudication is present, bowel and/or bladder incontinence is reported, and/or tumors are suspected. 

• 1 Cushnie D, Johnstone R, Urquhart JC, Gurr KR, Bailey SI, Bailey CS. Quality of Life and Slip Progression in Degenerative Spondylolisthesis Treated Nonoperatively. Spine (Phila Pa 1976). 2018;43(10):E574-E579. doi: 10.1097/BRS.0000000000002429
• 2 Li N, Scofield J, Mangham P, Cooper J, Sherman W, Kaye A. Spondylolisthesis. Orthop Rev (Pavia). 2022 Jul 27;14(4):36917. doi: 10.52965/001c.36917 . PMID: 35910544; PMCID: PMC9329062.
• 3 García-Ramos CL, Valenzuela-González J, Baeza-Álvarez VB, Rosales-Olivarez LM, Alpizar-Aguirre A, Reyes-Sánchez A. Degenerative spondylolisthesis I: general principles. Espondilolistesis degenerativa lumbar I: principios generales. Acta Ortop Mex. 2020;34(5):324-328..
• 4 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. Published 2016 Dec 1. doi: 10.1016/j.jot.2016.11.001
• 5 Kalichman L, Hunter DJ. Diagnosis and conservative management of degenerative lumbar spondylolisthesis. Eur Spine J. 2008;17(3):327-335. doi: 10.1007/s00586-007-0543-3
• 6 Studnicka K, Ampat G. Lumbosacral Spondylolisthesis. [Updated 2022 Sep 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560679/
• 7 Akkawi I, Zmerly H. Degenerative Spondylolisthesis: A Narrative Review. Acta Biomed. 2022;92(6):e2021313. Published 2022 Jan 19. doi: 10.23750/abm.v92i6.10526
• 8 Matz PG, Meagher RJ, Lamer T, et al. North American Spine Society. Clinical Guidelines for Multidisciplinary Spine Care. Diagnosis and Treatment of Degenerative Lumbar Spondylolisthesis. 2nd ed.; 2016.

Dr. Marco Funiciello is a physiatrist with Princeton Spine and Joint Center. He has a decade of clinical experience caring for spine and muscle conditions with non-surgical treatments.

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Spondylolisthesis

What is Spondylolisthesis?

Patient education video.

Types of Spondylolisthesis

What Are the Signs and Symptoms of Spondylolisthesis?

How is it diagnosed.

• Grade I – Less than 25 percent slippage
• Grade II – Between 25 and 50 percent slippage
• Grade III – Between 50 and 75 percent slippage
• Grade IV – More than 75 percent slippage
• Grade V – The upper vertebral body has slipped all the way off the front of the lower vertebral body. This is a rare situation that is called a spondyloptosis.

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StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

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Spondylolisthesis.

Steven Tenny ; Andrew Hanna ; Christopher C. Gillis .

Affiliations

Last Update: May 22, 2023 .

• Continuing Education Activity

Spondylolisthesis is a condition that occurs when one vertebral body slips with respect to the adjacent vertebral body causing radicular or mechanical symptoms or pain. It is graded based on the degree of slippage of one vertebral body on the adjacent vertebral body. Any pathological process that can weaken the supports keeping vertebral bodies aligned can allow spondylolisthesis to occur. This activity illustrates the evaluation and management of spondylolisthesis and reviews the role of the interprofessional team in improving care for patients with this condition.

• Describe the pathophysiology of spondylolisthesis.
• Review the workup of a patient with spondylolisthesis.
• Summarize the treatment options for spondylolisthesis.
• Describee the importance of collaboration and communication among the interprofessional team in encouraging weight loss in patients to reduce symptoms and increase the quality of life in those with spondylolisthesis.
• Introduction

Spondylolisthesis is the slippage of one vertebral body with respect to the adjacent vertebral body causing mechanical or radicular symptoms or pain. It can be due to congenital, acquired, or idiopathic causes. Spondylolisthesis is graded based on the degree of slippage of one vertebral body on the adjacent vertebral body. [1]

Spondylolisthesis commonly classifies as one of five major etiologies: degenerative, isthmic, traumatic, dysplastic, or pathologic. Degenerative spondylolisthesis occurs from degenerative changes in the spine without any defect in the pars interarticularis. It is usually related to the combined facet joint and disc degeneration leading to instability and forward movement of one vertebral body relative to the adjacent vertebral body. Isthmic spondylolisthesis results from defects in the pars interarticularis. The cause of isthmic spondylolisthesis is undetermined, but a possible etiology includes microtrauma in adolescence related to sports such as wrestling, football, and gymnastics, where repeated lumbar extension occurs. Traumatic spondylolisthesis occurs after fractures of the pars interarticularis or the facet joint structure and is most common after trauma. Dysplastic spondylolisthesis is congenital and secondary to variation in the orientation of the facet joints to an abnormal alignment.  In dysplastic spondylolisthesis, the facet joints are more sagittally oriented than the typical coronal orientation. Pathologic spondylolisthesis can be from systemic causes such as bone or connective tissue disorders or a focal process, including infection, neoplasm, or iatrogenic origin. Additional risk factors for spondylolisthesis include a first-degree relative with spondylolisthesis, scoliosis, or occult spina bifida at the S1 level. [1]

• Epidemiology

Spondylolisthesis most commonly occurs in the lower lumbar spine but can also occur in the cervical spine and rarely, except for trauma, in the thoracic spine. Degenerative spondylolisthesis predominately occurs in adults and is more common in females than males with increased risk in the obese. Isthmic spondylolisthesis is more common in the adolescent and young adult population but may go unrecognized until symptoms develop in adulthood. There is a higher prevalence of isthmic spondylolisthesis in males. Dysplastic spondylolisthesis is more common in the pediatric population, with females more commonly affected than males. Current estimates for prevalence are 6 to 7% for isthmic spondylolisthesis by the age of 18 years, and up to 18% of adult patients undergoing MRI of the lumbar spine. Grade I spondylolisthesis accounts for 75% of all cases. Spondylolisthesis most commonly occurs at the L5-S1 level with an anterior translation of the L5 vertebral body on the S1 vertebral body. The L4-5 level is the second most common location for spondylolisthesis. 

• Pathophysiology

Any process that can weaken the supports keeping vertebral bodies aligned can allow spondylolisthesis to occur. As one vertebra moves relative to the adjacent vertebrae, local pain can occur from mechanical motion or radicular or myelopathic pain can occur due to compression of the exiting nerve roots or spinal cord, respectively. Pediatric patients are more likely to increase spondylolisthesis grade when going through puberty. Older patients with lower grades I or II spondylolistheses are less likely to progress to higher grades over time.

• History and Physical

Patients typically have intermittent and localized low back pain for lumbar spondylolisthesis and localized neck pain for cervical spondylolisthesis. The pain is exacerbated by flexing and extending at the affected segment, as this can cause mechanic pain from motion. Pain may be exacerbated by direct palpation of the affected segment. Pain can also be radicular in nature as the exiting nerve roots become compressed due to the narrowing of nerve foramina as one vertebra slips on the adjacent vertebrae, the traversing nerve root (root to the level below) can also be impinged through associated lateral recess narrowing, disc protrusion, or central stenosis. Pain can sometimes improve in certain positions such as lying supine. This improvement is due to the instability of the spondylolisthesis that reduces with supine posture, thus relieving the pressure on the bony elements as well as opening the spinal canal or neural foramen. Other symptoms associated with lumbar spondylolisthesis include buttock pain, numbness, or weakness in the leg(s), difficulty walking, and rarely loss of bowel or bladder control.

Anteroposterior and lateral plain films, as well as lateral flexion-extension plain films, are the standard for the initial diagnosis of spondylolisthesis. One is looking for the abnormal alignment of one vertebral body to the next as well as possible motion with flexion and extension, which would indicate instability. In isthmic spondylolisthesis, there may be a pars defect, which is termed the "Scotty dog collar." The "Scotty dog collar" shows a hyperdensity where the collar would be on the cartoon dog, which represents the fracture of the pars interarticularis. Computed tomography (CT) of the spine provides the highest sensitivity and specificity for diagnosing spondylolisthesis. Spondylolisthesis can be better appreciated on sagittal reconstructions as compared to axial CT imaging. MRI of the spine can show associated soft tissue and disc abnormalities, but it is relatively more challenging to appreciate bony detail and a potential pars defect on MRI. [2] [3]

• Treatment / Management

For grade I and II spondylolisthesis, treatment typically begins with conservative therapy, including nonsteroidal anti-inflammatory drugs (NSAIDs), heat, light exercise, traction, bracing, and/or bed rest. Approximately 10% to 15% of younger patients with low-grade spondylolisthesis will fail conservative treatment and need surgical treatment. No definitive standards exist for surgical treatment. Surgical treatment includes a varying combination of decompression, fusion with or without instrumentation, or interbody fusion. Patients with instability are more likely to require operative intervention.  Some surgeons recommend a reduction of the spondylolisthesis if able as this not only decreases foraminal narrowing but also can improve spinopelvic sagittal alignment and decrease the risk for further degenerative spinal changes in the future. The reduction can be more difficult and riskier in higher grades and impacted spondylolisthesis. [4] [5] [6] [7] [8] [2] [9] [10]

• Differential Diagnosis
• Degenerative  Lumbar Disc Disease
• Lumbar Disc Problems
• Lumbosacral Disc Injuries
• Lumbosacral Discogenic Pain Syndrome
• Lumbosacral Facet Syndrome
• Lumbosacral Radiculopathy
• Lumbosacral Spine Acute Bony Injuries
• Lumbosacral Spondylosis
• Myofascial Pain in Athletes
• Pearls and Other Issues

Meyerding’s classification of spondylolisthesis is the most commonly used grading method. Its basis is on the percentage of anterior translation relative to the adjacent level. Grade I spondylolisthesis is 1 to 25% slippage, grade II is up to 50% slippage, grade III is up to 75% slippage, and grade IV is 76-100% slippage. If there is more than 100% slippage, it is known as spondyloptosis or grade V spondylolisthesis.  

Subclasses of isthmic spondylolisthesis are subtype A (stress fractures of the pars), subtype B (elongation of the pars without overt fracture), subtype C (acute fracture of the pars).

Subclasses of pathologic spondylolisthesis are subtype A (systemic causes) and subtype B (focal processes).

• Enhancing Healthcare Team Outcomes

An interprofessional team consisting of a specialty-trained orthopedic nurse, a physical therapist, and an orthopedic surgeon or neurosurgeon will provide the best outcome and long-term care of patients with degenerative spondylolisthesis. Chiropractors may also have involvement, as they may be the first to encounter the condition on X-rays. The treating clinician will decide on the management plan, and then have the other team members engaged - surgical cases with include the nursing staff in pre-, intra-, and post-operative care, and coordinating with PT for rehabilitation. In non-operative cases, the PT will keep the rest of the team informed of progress or lack thereof. The team should encourage weight loss as weight reduction may reduce symptoms and increase the quality of life. Interprofessional collaboration, as above, will drive patient outcomes to their best results. [Level 5]

• Review Questions
• Access free multiple choice questions on this topic.
• Comment on this article.

Lumbar Spine Sagittal CT of L5-S1, Grade II Spondylolisthesis Contributed by Christopher Gillis, MD, and Steven Tenny, MD

Disclosure: Steven Tenny declares no relevant financial relationships with ineligible companies.

Disclosure: Andrew Hanna declares no relevant financial relationships with ineligible companies.

Disclosure: Christopher Gillis declares no relevant financial relationships with ineligible companies.

This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.

• Cite this Page Tenny S, Hanna A, Gillis CC. Spondylolisthesis. [Updated 2023 May 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

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• Isthmic Spondylolisthesis. [StatPearls. 2024] Isthmic Spondylolisthesis. Burton MR, Dowling TJ, Mesfin FB. StatPearls. 2024 Jan
• High-grade slippage of the lumbar spine in a rat model of spondylolisthesis: effects of cyclooxygenase-2 inhibitor on its deformity. [Spine (Phila Pa 1976). 2006] High-grade slippage of the lumbar spine in a rat model of spondylolisthesis: effects of cyclooxygenase-2 inhibitor on its deformity. Komatsubara S, Sairyo K, Katoh S, Sakamaki T, Higashino K, Yasui N. Spine (Phila Pa 1976). 2006 Jul 15; 31(16):E528-34.
• [Three vertebral reduction and fixation for revision of lumbar spondylolisthesis]. [Zhongguo Gu Shang. 2014] [Three vertebral reduction and fixation for revision of lumbar spondylolisthesis]. Li CS. Zhongguo Gu Shang. 2014 Sep; 27(9):717-21.
• Review A review of the pathomechanism of forward slippage in pediatric spondylolysis: the Tokushima theory of growth plate slippage. [J Med Invest. 2015] Review A review of the pathomechanism of forward slippage in pediatric spondylolysis: the Tokushima theory of growth plate slippage. Sairyo K, Nagamachi A, Matsuura T, Higashino K, Sakai T, Suzue N, Hamada D, Takata Y, Goto T, Nishisho T, et al. J Med Invest. 2015; 62(1-2):11-8.
• Review Spondylolisthesis. [Orthop Rev (Pavia). 2022] Review Spondylolisthesis. Li N, Scofield J, Mangham P, Cooper J, Sherman W, Kaye A. Orthop Rev (Pavia). 2022; 14(4):36917. Epub 2022 Jul 27.

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Spondylolysis

What is spondylolysis.

Spondylolysis. Pars defect. Stress fracture. These three terms are used interchangeably, all referring to the same condition. Spondylolysis is a stress fracture through the pars interarticularis of the lumbar vertebrae. The pars interarticularis is a thin bone segment joining two vertebrae. It is the most likely area to be affected by repetitive stress. This condition is fairly common and is found in one out of every 20 people.

What are the symptoms of spondylolysis?

Spondylolysis doesn’t always have symptoms. When it does, the only symptom is usually back pain . The pain often gets worse with activity and sport, and is more notable when bending backward. Generally, the pain doesn’t interfere with everyday activities. If it persists, it is recommended to seek medical attention.

What are the risk factors for spondylolysis?

Being human and walking upright is the most basic risk factor for spondylolysis. The natural inward curvature of the lower back puts stress on the pars interarticularis. Certain sports that involve excessive or repetitive bending backward may increase the risk of spondylolysis. Examples include gymnastics, football and soccer. Young athletes may sometimes develop spondylolysis as a result of overuse and hyperextension of the lower back. Genetics could also be a risk factor for some people.;

Spondylolysis Diagnosis

If you have long-lasting, localized low-back pain, it could be due to spondylolysis. An X-ray is sometimes sufficient to defect a stress fracture. However, if pain persists despite rest and physical therapy, additional imaging may be necessary. Your doctor may need to order an MRI, a CT scan or a nuclear medicine bone scan with SPECT of the lumbar spine  for a definitive diagnosis.

Spondylolysis Treatment

Spondylolysis treatment focuses on managing the pain and helping you return to your daily activities. This condition doesn't typically put you at risk for spinal cord injury or nerve damage. Depending on the degree of pain, treatment options include:

• Rest/break from sports
• Nonsteroidal anti-inflammatory drugs
• Physical therapy for muscle strengthening and general conditioning
• A lumbar brace

Surgery to repair the fracture is rarely needed, as the pain is expected to fade over time in most cases.

Surgery for Spondylolysis

Surgery may be an option for adolescents with lumbar spondylolysis if other treatments have not helped. The fracture can be repaired by using a strong titanium screw. It is not a spine fusion. This surgery is done by making a 2- to 3-inch incision in the middle of the lower back. The screw is placed to secure the two sides of the fracture together, providing some compression across the area. Then a  bone graft  (a piece of bone from elsewhere in the body) could be used to further support the repair.  The surgery takes two hours, followed by one day in the hospital for recovery. Most adolescents will need to take one to two weeks out of school for recovery at home. Sports and rigorous exercises are restricted for three months after the surgery. This surgery is very successful in eliminating back pain related to spondylolysis. Most people are able to return to their previous level of sports and exercise without pain. 

Your doctor may also recommend a surgical procedure such as  spinal fusion  if it’s found that spondylolysis has caused your vertebra to slip forward. This slippage is called spondylolisthesis, which is a different but related condition.

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Professional Faqs: What Can I Do To Prevent Spondylolisthesis From Getting Worse?

Expert opinion from marcella abunahman pereira, specialization in clinical cardiology · 12 years of experience · brazil.

Spondylolisthesis is a spinal condition that causes back pain . It occurs when one of your vertebrae, the bones of your spine, slips out of place onto the vertebra below it. It can occur anywhere in the spine but is most common in the lower back. To prevent it, you should do regular exercises to strengthen your back and abdominal muscles. Also maintain a healthy weight because excess weight puts added stress on your back, quit smoking and eat a well-balanced diet to keep your bones strong.

Expert opinion from Rajesh Mishra

Mbbs · less than a year of experience · india.

Step 1: Lie on your back with your knees bent and your feet flat on the floor. Step 2: Pull your belly button in toward your spine using your abdominal muscles and flatten your lower back onto the floor. Step 3: Keeping your core muscles engaged, hold the position for 15 seconds. And then relax.

→ Learn more about spondylolisthesis: See the causes, symptoms, treatment options and more.

→ See more questions and expert answers related to spondylolisthesis.

Expert opinion from Ilya Aleksandrovskiy

M.d., mba · 5 years of experience · usa.

You can prevent spondylolisthesis from getting worsen by: *Do exercise for strong back and abdominal muscles. *Maintain healthy-weight. *Eat healthy and balanced diet to nourish your bone.

Disclaimer: This is for information purpose only, and should not be considered as a substitute for medical expertise. These are opinions from an external panel of individual doctors, and not to be considered as opinion of Microsoft. Please seek professional help regarding any health conditions or concerns.

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How Long Does Sciatica Last? Understanding the Duration and Finding Relief

• How Long It Lasts
• Causes of Flares
• Managing at Home
• Can It Go Away on Its Own?
• When to Call a Provider

Sciatica is pain that starts in the lower back and travels into the hips, buttocks, and down the legs. It waxes and wanes, causing episodes or flare-ups (periods of pain and other symptoms) that can last up to six weeks.

The duration of a sciatica episode may vary depending on the severity of the cause, the severity of other lower back and hip symptoms, and whether the sciatica is acute (short term) or chronic (long term). Most people experience sciatica nerve pain if the nerve roots that make up the sciatic nerve become pinched or compressed. Sciatica typically affects one side of the body. 

This article explores the symptoms of sciatica, how to treat it, how long it lasts, and when to contact a healthcare provider.

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What Does Sciatica Feel Like?

The term "sciatica" refers to pain that travels along the path of the sciatic nerve . The sciatic nerve is the largest nerve in the body. You have two sciatic nerves, one on each side of the body.

Your sciatic nerve originates in the spinal cord in the lower back. It starts in the lower back and runs down the back of the leg.  Nerve compression in the lower back can cause pain anywhere along the sciatic nerve, starting at the lower back and down to the bottom of the foot.

A primary symptom of sciatica is nerve pain that runs from the lower back down the buttock and down the back of the thigh. Symptoms typically affect the leg or buttock and are even felt below the knee. But this may vary from person to person. 

In addition to pain, sciatica also causes:

• Leg weakness
• Aching 
• Burning 
• Muscle spasms and cramping 
• Difficulty moving the leg on the affected side
• Bowel and bladder changes if sciatica is severe 

Sciatica symptoms are worse when sitting or coughing. Walking, bending, and sitting for too long may also worsen symptoms. Some people might also experience worsening symptoms at night because they lie in one position. 

About 10% of people with lower back pain have sciatica. Sciatica is more common after age 40. 

Various conditions can lead to sciatica, including:

• A herniated disc
• Degenerative disc disease
• Spinal stenosis
• Foraminal stenosis
• Spondylolisthesis
• Osteoarthritis
• Cauda equina syndrome
• A spinal tumor (rare)

How Long Does Sciatica in Pregnancy Last?

Some people may experience sciatica pain while pregnant . Sciatica is more common in the third trimester of pregnancy. Fortunately, sciatica typically resolves after childbirth.

How Long Does Sciatica Last?

Sciatica is either acute or chronic. Acute sciatica refers to one sciatic attack or episode that resolves in a week or two, but sometimes, acute episodes can take up to six weeks to resolve. Acute sciatica might become chronic, where you experience sciatica pain regularly. 

Acute Sciatica

Episodes of acute sciatica can affect walking, standing, sitting, and lying comfortably. They can cause burning pain down the back, buttocks, and legs. 

Most people who experience acute sciatica will not have ongoing discomfort. However, without any warning, they might have an acute flare-up that forces them to rest and experience sciatica symptoms for days or weeks. Once you recover from an acute episode, you may not have another one for many months or even years.

Acute sciatic pain can affect you anywhere on the sciatic nerve—the lower back, buttocks, thighs, or feet. The more areas it involves, the worse the pain and symptoms.

Chronic Sciatica

People with chronic sciatica regularly experience sciatic nerve pain. Sciatica is considered chronic if it has lasted longer than six months.

Chronic sciatica can cause significant pain, numbness, and weakness. Symptoms can interfere with your ability to do daily activities. Chronic sciatica is typically a lifelong condition that does not always respond well to treatment.

Some people with chronic sciatica may experience central sensitization , a secondary complication of sciatica in which the nervous system amplifies pain. 

What Causes a Sciatic Flare-Up?

For some people, sciatica may be a onetime occurrence. However, for others, especially people with chronic sciatica, sciatica flares are frequent. 

There is no single trigger that may cause your sciatica to flare. Symptoms may present differently from flare to flare. 

Some potential causes are: 

• Not being active : If you stay in the same position for too long, your sciatica can flare up.
• Weight gain : Added weight can add stress to the sciatic nerve.
• Poor posture : Poor posture and improper body alignment (such as an awkward sitting position) can put additional stress on your lower back and sciatic nerve.
• Weather : Some people with sciatica report that harsh weather changes related to barometric pressure can trigger flare-ups. Barometric pressure has been found to cause changes in the bones, joints, muscles, nerves, tendons, and other body tissues. It is possible that such weather changes could affect the sciatic nerve and potentially trigger a flare-up. 

How to Manage Sciatic Pain at Home

Most people can manage sciatica pain at home. Call a healthcare provider if the pain is not manageable or if you have other health concerns. 

Ways to manage sciatica pain at home are:

• Keep moving : Movement is one of the best ways to manage pain. While it is OK to rest for the first day or two, you should move to strengthen your back and leg muscles, improve your flexibility and range of motion, boost blood flow, and reduce pain perception.
• Ice and heat : Consider using cold therapy for the first seven days of a sciatica flare. Wrap ice packs in a towel or cloth and leave them in place for 15 to 20 minutes at a time, with 15 to 20 minutes in between. Heat can be used after the first week and can include heating pads, hot water bottles, and warm baths or showers. Place a cloth between your body and the heat source with heating pads and water bottles.
• Sleep on a comfortable mattress : Sleeping on a softer mattress can increase spinal pressure and move discs out of alignment. Consider investing in a firmer mattress or a firm mattress topper to help you get a better night's sleep and keep sciatica symptoms at bay.
• Avoid sitting or standing for too long : Sciatica pain can worsen with prolonged sitting or standing. Consider getting up and moving after sitting for a half hour. If you have to stand or sit in one place, lift your foot on the affected side onto a box every half hour or rest your foot on a stool or small box.
• Take over-the-counter (OTC) nonsteroidal anti-inflammatory drugs (NSAIDs) : NSAIDs , including Advil or Motrin (ibuprofen), Aleve (naproxen sodium), and aspirin, can relieve sciatica pain and stiffness.

Can Sciatic Pain Go Away on Its Own?

Mild sciatica might go away without any medicinal treatment. It may still take up to six weeks for symptoms to completely resolve. 

You can manage mild sciatica at home with home remedies and lifestyle changes. If symptoms worsen or do not appear to be improving, you may want to reach out to a healthcare provider. They may prescribe medication or physical therapy to help you manage pain.

Four Stages of Sciatica Healing

Sciatica goes through a series of healing stages, which can eventually lead to full recovery. Those stages are:

• Reducing inflammation : The first stage begins with managing nerve inflammation. Over-the-counter anti-inflammatory medicines, cold therapy, rest, and activity can manage inflammation. 
• Oxygenation : Once inflammation is reduced, the affected sciatic nerve area will receive more oxygen to help regenerate cells that lost oxygenation due to the inflammation.
• Regeneration of nerve cells : Nerve cell regeneration allows numbness to resolve and sensation to return.
• Nerve rehabilitation and desensitization : This last phase means full recovery in which there is no longer any shooting pain, localized pain, or numbness and tingling.

Lifestyle Changes to Prevent Sciatica Flare-Ups

Many lifestyle changes can help you to prevent sciatica flare-ups. These include:

• Regular exercise : Keep moving to reduce your risk for sciatica flares. Movement can prevent a flare by building up strength in your lower back and relieving muscle tension in the sciatic nerve.
• Practicing good posture : Good posture protects the back from excess pressure and may reduce sciatica risk. Instead of hunching over or slouching, correct your posture and keep your back muscles strong. Good posture maintains the spine's natural curves at the neck, middle back, and lower back. That means your head is above your shoulders, and your shoulders are just above your hips.
• Not sitting for long periods : Take regular breaks from sitting. Try to stand or walk around every 30 minutes. If your job does not allow you to move around or stand every 30 minutes, move around in your chair every 15 minutes to shift your weight. You should also avoid standing for long periods to prevent excess pressure on the spine, which can lead to sciatica pain. 
• Proper lifting/body mechanics : Lift with your legs and hips rather than your back. Keep your back straight and bend the knees so your lower body does the work. If you need to lift something heavy, find someone to help. Avoid lifting and twisting at the same time. 
• Maintain a healthy weight : Excess weight can stress the spine and put pressure on discs. If you are overweight, work with a healthcare provider to find an eating plan and exercise program that helps you reach and stay at a healthy weight.
• Manage stress : Stress can increase inflammation and muscle tension, which may trigger pain in the sciatic nerve. Try meditation, deep breathing, yoga, and stretching to reduce stress and help you feel relaxed.
• Not smoking : Smoking can lead to spinal problems, which can increase your sciatica risk. It can also increase recovery time if you have sciatica or other lower back problems. If you smoke, talk to a healthcare provider and make a plan to quit . Consider contacting your health insurance company to see if it offers smoking cessation programs or other resources.

When to Contact a Healthcare Provider

Most people can manage sciatica at home, and mild sciatica can be resolved over time. But if sciatica symptoms last more than a week or get worse, contact your healthcare provider. 

Get immediate medical care for the following:

• Severe and sharp pain in the lower back that radiates into the legs
• Problems controlling the bladder or bowel 
• Pain after a traumatic injury, such as a sports injury or automobile accident 
• Sudden numbness and weakness in one or both legs
• Saddle anesthesia, which is a loss of sensation on the area of the buttocks, perineum (area between the genitals and anus), and inner surfaces of the sides

Medical Treatments for Sciatica

If you are not able to manage sciatica at home, a healthcare provider can recommend or prescribe additional treatments. Such treatments include:

• Physical therapy : A physical therapist can teach you how to manage sciatica symptoms by stretching, improving posture , and strengthening your core muscles to support your back.
• Alternative therapies : Alternative therapies, including deep tissue massage and acupuncture , can help ease pain and discomfort caused by sciatica.
• Medications : When NSAIDs do not help address sciatica pain, a healthcare provider can prescribe medications like Neurontin ( gabapentin ) that target nerve pain. Muscle relaxers , anticonvulsant drugs , low-dose antidepressants, and oral and injection corticosteroids might also be helpful for targeting inflammation and sciatic nerve pain.
• Surgery : Surgery is a last resort option to manage an underlying condition that leads to sciatic nerve pain, such as herniated discs and spinal stenosis . 

Sciatica can be a painful condition. It can cause flares that make it hard to perform daily activities. A sciatica flare can resolve in a couple of weeks, but it can last up to six weeks.

You can manage sciatica pain at home with rest, exercise, heat and cold therapies, OTC pain relievers, and not sitting for long periods. Sciatica flares can be prevented with a variety of lifestyle changes, including staying active, practicing good posture, maintaining a healthy weight, and not smoking. 

If at-home therapies and lifestyle changes do not help manage sciatica symptoms, your healthcare provider can prescribe additional treatments. Such treatments may include muscle relaxers and medicines that target nerve pain, physical therapy, or surgery as a last resort. 

Talk to your healthcare provider if your sciatica symptoms do not improve with home treatment, last for long periods, or keep returning. They can examine you to determine the cause of your pain and develop a treatment plan.

You should seek out immediate medical help for severe or sharp pain in your lower back, bladder or bowel dysfunction, pain after a traumatic injury, sudden numbness and weakness in one or both legs, or saddle anesthesia. 

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By Lana Barhum Barhum is a freelance medical writer with 15 years of experience with a focus on living and coping with chronic diseases.