Spondylolisthesis

What spondylolisthesis is

The spine is a stack of vertebrae held in place by discs, joints and ligaments. In spondylolisthesis, a vertebra moves forward relative to the one beneath it, most often in the lower back. It is commonly described by its cause: wear and tear of the discs and facet joints (degenerative), or a stress fracture in a small part of the vertebra (spondylolysis), which is more often seen in young athletes. Injury and other conditions can also be involved.

Many people with a slip have mild symptoms or none. Pain usually comes from the joints, discs or irritated nerves around the slipped segment, which is why the evaluation looks at the source of pain, not just the X-ray.

Common symptoms

• Low back pain or stiffness, often worse with standing, walking or bending backward
• Tight hamstrings or a change in posture or walking
• Pain, tingling or numbness that travels into the buttock or leg when a nerve is irritated

Seek emergency care right away for new loss of bladder or bowel control, numbness in the groin or saddle area, or fast-worsening leg weakness. Call 911 or go to the nearest emergency room.

How it is evaluated

Evaluation focuses on identifying the main pain generator. A physician-led assessment may include a detailed history, a physical examination, review of prior imaging such as standing X-rays or MRI, and, when appropriate, image-guided diagnostic injections to confirm which structure is causing pain. Imaging findings alone do not always explain symptoms, so they are read together with your examination.

Non-surgical options that may be discussed

Treatment depends on the cause, the degree of slip and your symptoms. Many people are first managed without surgery. Options that may be discussed include:

• Activity changes and coordinated physical therapy or rehabilitation
• Epidural steroid injections for nerve-related leg pain
• Facet joint injections, medial branch blocks and radiofrequency ablation when the facet joints are the source
• SI joint injections when the sacroiliac joint contributes

Surgical evaluation may be recommended when there is a significant or worsening slip, progressive weakness, or symptoms that do not improve with appropriate non-surgical care. Dr. Palvia helps patients understand whether surgery is truly necessary and which alternatives may be appropriate. See also spinal stenosis, back pain and sciatica.

See a physician in Brooklyn

Motionis Medicine is at 409 Fulton Street, 2nd Floor, Brooklyn, NY 11201. See what to expect at your first visit or the interventional pain management overview.

Frequently asked questions