Home / Conditions / Spondylolisthesis
One vertebra slipping forward on the one below. In young, active people it usually starts with a stress fracture; in older adults, with wear — and the two are managed quite differently.
The vertebrae in the lower back are held in line by the discs between them and by small joints at the back. Spondylolisthesis is when one vertebra slides forward relative to the one beneath it. The slip can press on the nerves, narrow the spinal canal, or simply make that part of the spine a source of pain.
The amount of slip is graded on an X-ray by how far the vertebra has moved across the one below: grade I is less than a quarter, grade II up to half, grades III and IV more, and grade V is a complete slip. Most people have grade I or II.
This is the older, wear-related type. The L4 vertebra has moved forward on L5, at the level where degenerative slips usually happen, and by the modest amount most adults with the condition have.
What a drawing cannot show is movement. Some slips shift further when you bend forward and back. That is why bending X-rays are taken, and a slip that moves is one of the things weighed if surgery is being considered.
Four words that sound alike. Spondylosis is general wear of the spine. Spondylolysis is a stress fracture in a small bridge of bone at the back of a vertebra. Spondylolisthesis is a vertebra that has slipped — sometimes because of that fracture. Spondylitis is inflammation, as in ankylosing spondylitis.
Most spondylolisthesis falls into one of two groups. Which one it is shapes almost everything that follows.
| Isthmic (young) | Degenerative (older) | |
|---|---|---|
| Who | Children, teenagers and young adults, often active in sport | Adults, usually over 50, more often women |
| Level | Usually L5 on S1 | Usually L4 on L5 |
| Cause | A stress fracture in the back of the vertebra (spondylolysis), often from repeated arching and twisting | Wear of the disc and the small joints that hold the vertebra in place |
| Typical symptoms | Lower back pain with activity, and tight hamstrings | Leg pain, heaviness or numbness on walking, from narrowing of the canal |
| Main concern | Whether the slip increases while still growing | Pressure on the nerves, as in spinal stenosis |
Sports that load the lower back in arching and rotation — gymnastics, fast bowling, diving, weightlifting — are the usual background to the isthmic type. The degenerative type often comes with the same walking symptoms as stenosis.
Call us on +65 8849 0677. We will see you the same day and arrange imaging if it is needed.
If we are closed, go to an emergency department — we are shut on Sundays and after 1pm on Saturdays. For the first two symptoms, go straight to an emergency department whether we are open or not.
Call +65 8849 0677A slip can look smaller lying down. MRI is done lying flat, which can partly reduce the slip. Standing and bending X-rays show how the spine behaves under load, which is why they are usually needed as well.
Non-surgical treatment eases symptoms and helps the spine cope with the slip. It does not move the vertebra back into place, and it does not need to for most people to do well.
For young athletes, a pause from the sport or movements that arch and twist the back until the pain settles. Many return to sport afterwards. For adults, staying active within comfort, with walking paced as it would be for stenosis.
Core strengthening to support the lower back, hamstring stretching, and a graded return to activity.
Sometimes used for a recent stress fracture, to rest the area while it settles.
Anti-inflammatories for flare-ups, and image-guided injections for leg or joint pain that has not settled. Dr Tung works with radiologists to offer CT-guided nerve root and facet blocks.
Considered for pain or leg symptoms that stay disabling despite a proper course of non-surgical treatment, for weakness that is getting worse, or for a slip that is increasing in a young person.
A fusion takes several months to become solid, and up to a year to reach its final strength. More on the nerve-freeing part of the operation under decompression surgery.
A slipped vertebra is a problem of alignment and stability, which leans towards the orthopaedic side. When the slip is squeezing the nerves, the neurosurgical side is just as relevant.
Alignment, stability, how far it has moved, and whether it needs fixing.
An orthopaedic spine surgeon trains on the musculoskeletal system first. Dr Lim Heng Hing performs deformity correction and fusion, with robotic assistance for screw placement.
Leg pain, numbness or weakness from a canal narrowed by the slip.
A neurosurgeon trains on the nervous system first. Dr Mathew Tung performs spinal decompression and fusion (TLIF), foraminotomy, and CT-guided nerve blocks.
You do not need to pick correctly. Either is a sound first appointment, and having both surgeons in one clinic means the answer is not shaped by whichever one you happened to book.
More on how the two differ: neuro spine and orthopaedic spine surgery.
Spondylolysis is a stress fracture in a small bridge of bone at the back of a vertebra. Spondylolisthesis is when a vertebra has slipped forward. A spondylolysis can lead to a slip, but many do not.
Not with exercise, a brace or manipulation. Treatment aims to ease symptoms and help the spine cope with the slip. Where surgery is needed, the vertebra is fixed in position, and the slip is sometimes partly corrected at the same time.
Often, yes. Young athletes usually need a break from the activities that provoke pain while it settles, then a graded return. The right timing depends on the type of sport and whether the stress fracture is still healing.
Most low-grade slips stay stable. The main period of risk is during growth, which is why young people are monitored with X-rays. In adults, the slip itself tends to change slowly.
Most people do not. Fusion is for symptoms that stay disabling despite non-surgical treatment, for weakness that is getting worse, or for a slip that is increasing.
No. Bring any X-ray, CT or MRI reports, and mention any sport or activity that brings on the pain.
Spinal stenosis · Lower back pain · Back pain · Sciatica · Slipped disc · Facet joint syndrome · Scoliosis · Cervical spondylosis
If you have a standing X-ray already, bring it. A slip is best judged with the spine under load.
