Spondylolisthesis: Symptoms, Types, Causes and Treatment

Spondylolisthesis is a spinal condition that affects people of all ages, causing a vertebra to slip forward over the bone below it. While the term might sound intimidating, understanding its symptoms, types, causes, and modern treatments can empower patients and their families. This comprehensive guide unpacks the latest research, giving you the facts you need to recognize, understand, and manage spondylolisthesis.

Symptoms of Spondylolisthesis

Spondylolisthesis often presents in subtle ways at first, but as the condition progresses, symptoms can significantly impact daily life. Recognizing these early signs can help in seeking timely care and improving long-term outcomes.

Symptom	Description	Prevalence	Sources
Low back pain	Aching or sharp pain in the lower back	Most common symptom	1, 2, 3, 12, 18
Leg pain	Radiating pain, often described as sciatica	33-62% of patients	2, 3, 12, 18
Numbness	Tingling or loss of sensation, legs/feet	11-18%	3, 12, 5
Weakness	Muscle weakness, especially in lower limbs	9-18%	3, 12, 5

Table 1: Key Symptoms

Low Back Pain: The Most Common Complaint

Low back pain is the hallmark symptom of spondylolisthesis, reported by the majority of patients. The pain can range from a dull ache to sharp, stabbing discomfort. In both adults and children, low back pain may be persistent or intermittent, often worsening with activity or prolonged standing 1, 2, 3, 12, 18.

Leg Pain and Sciatica

Many patients also experience leg pain, commonly referred to as sciatica. This happens when the slipped vertebra compresses nerve roots, causing sharp or burning pain that radiates down one or both legs. In some studies, up to 62% of adults with spondylolisthesis reported both low back pain and sciatica, while a smaller percentage experienced only leg pain 2, 3, 12.

Neurologic Symptoms: Numbness and Weakness

With nerve involvement, spondylolisthesis can cause numbness (paresthesias) and weakness in the lower extremities. These symptoms are less common than pain but can be disabling. Functional limitations, such as difficulty walking or performing daily activities, may also develop 3, 12, 5.

Functional Disability

The degree of disability varies. Some people may only have mild discomfort, while others struggle with walking, shopping, or getting in and out of cars 3. Interestingly, studies show that the functional impact of spondylolisthesis can be similar to that of nonspecific low back pain, though those with widespread, non-organic pain patterns tend to report greater disability and longer periods off work 2.

Types of Spondylolisthesis

There are several distinct types of spondylolisthesis, each with its own underlying cause and typical patient profile. Accurately identifying the type is crucial for personalized treatment.

Type	Key Feature/Origin	Prevalence/Notes	Sources
Isthmic	Pars interarticularis defect	4–8% in general population	4, 10, 12
Degenerative	Facet/disc degeneration	Common in older adults	1, 7, 11, 12, 18
Dysplastic	Congenital bony malformation	Seen in children/adolescents	8, 12
Traumatic	Acute vertebral injury	Rare	12
Pathological	Tumors or bone disease	Very rare	12

Table 2: Main Types of Spondylolisthesis

Isthmic Spondylolisthesis

Isthmic spondylolisthesis arises from a defect, fracture, or elongation in the pars interarticularis—a small segment of bone joining facets in the vertebra. It often occurs in younger individuals, sometimes due to repetitive stress or hereditary factors. The L5-S1 level is most commonly affected 4, 10, 12.

Degenerative Spondylolisthesis

Degenerative spondylolisthesis is typically seen in adults over 50. Here, the slip occurs due to age-related changes in the facet joints and intervertebral discs, leading to instability. It’s a leading cause of spinal stenosis and may progress over time 1, 7, 11, 12, 18.

Dysplastic (Congenital) Spondylolisthesis

This form is caused by congenital defects in the formation of the lumbosacral vertebrae or their supporting structures. Dysplastic spondylolisthesis is often identified in children or adolescents and may progress as they grow 8, 12.

Traumatic and Pathological Types

These rare types result from acute trauma (vertebral fracture) or underlying bone disease/tumor, respectively. They require careful evaluation to determine the best course of action 12.

Classifications and Grading

Spondylolisthesis is also graded by the degree of slippage, most commonly using the Meyerding classification:

• Grade I: 0–25% slip
• Grade II: 25–50%
• Grade III: 50–75%
• Grade IV: 75–100%
• Grade V: >100% (spondyloptosis) 12

Newer systems incorporate sagittal balance and pelvic incidence, providing a more comprehensive framework for clinical decision-making 6, 12.

Causes of Spondylolisthesis

Understanding what leads to spondylolisthesis helps patients and clinicians focus on prevention and individualized treatment. Causes differ by type, age, and underlying risk factors.

Cause	Description	Risk Factors/Population	Sources
Pars defect/fracture	Break in vertebral arch	Youth, athletes, genetics	4, 8, 10, 12
Degeneration	Disc/facet joint wear and tear	Age >50, females, obesity	1, 7, 11, 13, 18
Congenital defects	Malformation at birth	Children, hereditary	8, 12
Trauma	Sudden injury	Any age	12
Pathology	Tumors, bone diseases	Rare, associated conditions	12

Table 3: Underlying Causes of Spondylolisthesis

Pars Interarticularis Defect

In isthmic spondylolisthesis, a stress fracture, elongation, or congenital defect in the pars interarticularis weakens spinal stability, allowing a vertebra to slip. This is common in children, adolescents, and athletes exposed to repetitive spine extension, such as gymnasts and football players. There’s also a hereditary component 4, 8, 10, 12.

Degenerative Changes

Degenerative spondylolisthesis is primarily due to age-related changes. The intervertebral discs lose height and hydration, and facet joints become arthritic and lax. This instability allows one vertebra to slide forward, most commonly at L4-L5. Risk increases with age, female sex, obesity, certain ethnic backgrounds, and changes in bone mineral density or hormonal balance 1, 7, 11, 13, 18.

Congenital Malformations

Dysplastic or congenital spondylolisthesis results from abnormal development of the vertebral elements at birth. These defects can predispose the spine to slippage as the child grows 8, 12.

Traumatic and Pathological Causes

Acute trauma (such as a fracture) or bone-weakening diseases (like tumors) can destabilize the spine, leading to slippage. These are less common but important to recognize 12.

Predisposing Factors

Research identifies several factors that can increase the risk of developing degenerative spondylolisthesis:

• Age: Prevalence rises with age, especially after 50.
• Gender: Women, especially postmenopausal, are more often affected.
• Obesity: Increased body weight adds stress to spinal structures.
• Bone mineral density: Changes may affect stability.
• Ethnicity: Some populations show higher rates 13.

Treatment of Spondylolisthesis

Treatment for spondylolisthesis ranges from conservative approaches to surgical intervention. The choice depends on the type, severity, symptoms, and patient preferences.

Treatment	Approach/Goal	Indications/Notes	Sources
Conservative	Pain relief, improve function	Most cases, esp. mild/moderate	1, 4, 8, 17, 18
Physical therapy	Strengthening, flexibility	First-line, all ages	1, 17, 18
Medications	NSAIDs, analgesics	Symptom control	1, 17, 18
Injections	Epidural steroids	Severe pain, nerve symptoms	1, 17, 18
Bracing	External support	Children, select adults	1, 4, 8
Surgery	Decompression, fusion, correction	Failed conservative care, severe symptoms	4, 14, 15, 16, 17, 18

Table 4: Main Treatment Approaches

Conservative (Nonoperative) Treatment

Most patients with spondylolisthesis—especially those with mild or moderate symptoms—benefit from nonoperative management as a first step:

• Physical therapy: Focuses on core strengthening, flexibility, and posture.
• Medications: NSAIDs and analgesics control pain.
• Epidural steroid injections: May help with severe pain or nerve symptoms.
• Bracing: Especially helpful for children/adolescents and select adults 1, 4, 8, 17, 18.

Surgical Treatment

Surgery is considered for patients who:

• Do not improve after a period (typically several months) of conservative care
• Have progressive neurologic symptoms (weakness, numbness, bowel/bladder dysfunction)
• Develop significant functional disability or spinal deformity

Surgical options include:

• Decompression: Removes bone or tissue compressing nerves.
• Spinal fusion: Stabilizes the spine by joining (fusing) two or more vertebrae.
• Instrumentation: Use of rods, screws, cages for added support.
• Reduction: Realignment of the slipped vertebra (sometimes considered in high-grade slips or with postural imbalance) 4, 14, 15, 16, 17, 18.

Long-term studies show that surgery, particularly decompression with or without fusion, can provide greater improvements in pain and function compared to ongoing nonoperative care, especially for those with significant symptoms 14, 15. However, the decision is highly individualized and should involve a thorough discussion of risks, benefits, and patient goals.

Special Considerations

• Children/Adolescents: Most can be managed nonoperatively. Surgery is reserved for persistent pain, progression, or cosmetic concerns 8.
• Cervical Spondylolisthesis: Rare, but may require specific surgical techniques if spinal cord compression is present 5.
• Spinopelvic Balance: Recent research emphasizes the importance of restoring normal alignment and balance, particularly in high-grade slips 6, 12.

Conclusion

Spondylolisthesis is a complex spinal condition with a broad spectrum of causes, symptoms, and treatment options. Early recognition and individualized management are key to optimal outcomes.

Key Takeaways:

• Spondylolisthesis often causes low back pain, leg pain, and sometimes numbness or weakness.
• There are several types (isthmic, degenerative, dysplastic, traumatic, pathological), each with unique causes and typical patient profiles.
• Risk factors include age, gender, genetics, congenital defects, trauma, and bone health.
• Most cases can be managed with conservative treatment; surgery offers significant benefit for those with persistent or severe symptoms.
• Advances in classification and understanding of spinal balance are improving care and outcomes for patients.

If you or someone you know is experiencing symptoms suggestive of spondylolisthesis, a healthcare provider can help determine the best path forward, tailored to individual needs and lifestyle.