Spondylolisthesis

Spondylolisthesis occurs when a bone from the lower spine (a vertebra) slips out of position.

This is not to be confused with a slipped disc, when one of the spinal discs inbetween the vertebrae ruptures.

What are the symptoms?

Many people with spondylolisthesis may not realise they have the condition, because it doesn't always cause symptoms.

If you do have symptoms, these may be:

• lower back pain – which is usually worse with activity and when standing, and is often relieved by lying down
• pain, numbness or a tingling sensation radiating down your legs (sciatica) – this happens if the slipped vertebra is compressing a nerve
• tight hamstring muscles
• stiffness
• tenderness in your lower back
• excessive curvature of the spine (kyphosis)

The severity of these symptoms can vary considerably from person to person.

Causes of spondylolisthesis

In children, spondylolisthesis can occur as the result of a birth defect, such as having thin bones in that area of the spine, or can be due to a sudden injury.

In adults, it is most commonly caused by age-related wear of the spine or a degenerative disease, such as arthritis.

Other possible causes in adults are:

• a bone disease – such as Paget's disease of the bone
• a fracture as a result of a sudden injury
• a fracture as a result of sustained pressure on the spine – commonly seen in gymnasts and weight lifters

When to see your GP

You should see your GP if:

• you have persistent back pain or stiffness
• you have persistent pain in your thighs or buttocks
• your back curves outwards excessively

Your GP will physically examine you and may carry out a straight leg raise test. You will be asked to lie on your back, while your GP holds your foot and lifts your leg up, keeping your knee straight. This is often painful if you have spondylolisthesis.

An X-ray of your spine (taken when you are standing) will show if one of your bones is out of place, and whether you have a fracture.

Treatment and outlook

Treatment for spondylolisthesis varies, depending on the severity of your condition.

Non-surgical treatments

In most cases, non-surgical treatments will be recommended first, such as:

• anti-inflammatory painkillers or stronger painkillers available on prescription
• short periods of bed rest while you are experiencing symptoms, avoiding contact sports and trying not to over-stretch your spine
• simple strengthening and stretching exercises
• physiotherapy
• injections of steroid medication, with local anaesthetic around the compressed nerve and into the spinal canal

These measures will only provide temporary relief, but you may find symptoms go away with time anyway.

Back braces sometimes used to be recommended for spondylolisthesis, but there are concerns that bracing may actually weaken your spine, and may not improve your symptoms.

Surgery

If your symptoms are severe, persistent or suggest a nerve in your spine is being compressed, surgery may be recommended.

This will usually involve fusing the slipped vertebra to the neighbouring vertebrae using metal screws and rods, along with a piece of your own bone taken from a nearby area. The screws and rods will normally be left in permanently.

In some cases, your surgeon may also remove the spinal disc being compressed between your vertebrae, which will be replaced by a small "cage" containing a bone graft to hold your vertebrae apart.

The operation is performed under general anaesthetic, which means you will be asleep while it is carried out. 

Surgery is often effective in relieving many of the symptoms of spondylolisthesis, particularly pain and numbness in the legs.

However, this is a major operation involving up to a week in hospital and a recovery period lasting months, where you have to limit your activities. The procedure also carries a risk of potentially serious complications, so make sure you talk to your doctor or surgeon about the pros and cons of this treatment, and think about it carefully before deciding to undergo it.

Possible complications of spinal surgery for spondylolisthesis can include:

• infection at the site of the operation
• a blood clot developing in one of your leg veins – known as deep vein thrombosis (DVT)
• damage to the spinal nerves or cord – resulting in continuing symptoms, numbness or weakness in the legs or, in rare cases, some degree of paralysis, or loss of bowel or bladder control

Read more about lumbar decompression surgery, which is a type of spinal surgery.