Lumbar Spondylolisthesis

Lumbar spondylolisthesis is a condition in which one of the bones in your spine, called a vertebra, slips out of its proper position and moves forward over the bone directly beneath it. This misalignment can cause the vertebra or disc to press on nerves, leading to pain, discomfort, and other symptoms.

Understanding the Spine

The spine is made up of a series of bones called vertebrae, stacked to form the spinal column. This column supports your body, protects the spinal cord, and enables flexible movement. Normally, the vertebrae are aligned in a straight line and move smoothly against one another during bending, twisting, or stretching.

What Happens in Spondylolisthesis?

In spondylolisthesis, one vertebra slips out of place—typically moving forward over the vertebra below. This slippage can narrow the exit space for spinal nerves, leading to irritation or compression.

Types of Lumbar Spondylolisthesis

Type	Cause	Notes / Location
Congenital (Dysplastic)	Present at birth due to abnormal bone formation leading to instability.	Often affects the L5 vertebra, slipping forward on S1.
Isthmic	Defect or fracture in the pars interarticularis from repetitive stress or overuse.	Common in athletes (e.g., gymnasts, football players, weightlifters).
Degenerative	Age-related degeneration of discs and joints reduces stability.	Typically affects the L4-L5 level; more common in older adults.
Traumatic	Resulting from high-impact injury, tumor, infection, or bone disease weakening the vertebra.	Examples include car accidents or falls.
Pathologic	Acute injury causing fracture/dislocation leading to instability.	Associated with osteoporosis, Paget’s disease, or metastatic cancer.
Postsurgical	Occurs as a complication after spinal surgery due to removal of bone or joint structures.	Surgery (e.g., laminectomy) may lead to instability and slippage.

Grading of Spondylolisthesis

The degree of vertebral slippage is graded to help determine the best treatment approach:

Grade I: 0-25% slippage
Grade II: 26-50% slippage
Grade III: 51-75% slippage
Grade IV: 76-100% slippage
Grade V (Spondyloptosis): Complete slippage

Symptoms

Symptoms vary based on the extent of slippage and nerve compression. Common symptoms include:

Lower back pain: Often worsens with activity, especially when unstable.
Leg pain: Radiates down the legs similar to sciatica.
Muscle tightness: Particularly in the hamstrings.
Numbness or tingling: In the legs or feet.
Weakness: In the legs, more pronounced in severe cases.
Difficulty standing or walking: Due to pain or spinal instability.

Diagnosis

Lumbar spondylolisthesis is diagnosed through a combination of medical history, physical examination, and imaging tests (X-rays, MRI, or CT scans) to determine the extent of vertebral slippage and nerve compression.

Treatment

Treatment depends on symptom severity and may include:

Observation: Monitoring the condition with serial imaging when symptoms are minimal.
Physiotherapy: Exercises to strengthen core and gluteal muscles, improve flexibility, and stabilize the spine.
Pain Management: NSAIDs, pain relievers, or corticosteroid injections to control inflammation.
Activity Modification: Avoiding activities that exacerbate symptoms (e.g., heavy lifting).
Bracing: Using a back brace to support the spine and limit movement.
Surgery: Spinal fusion or other surgical interventions when conservative treatments fail or if deformity progresses.

Spinal Conditions

Guide to Understanding Spinal Conditions