Spondylolisthesis: History, Classification, Symptoms, Causes, Risk Factors, Diagnosis and Treatment

It is the sliding or displacement of one vertebra in comparison with another.

The word spondylolisthesis derives from spondylosis, which means backbone, and lists which means slip.

Spondylolisthesis usually occurs towards the base of the spine in the lumbar area. It is a condition of the spine by which one vertebrae slides forward or backward relative to the next vertebra.

The forward gliding of an upper vertebra in a lower vertebra is known as anterolisthesis, while the backward recoil is known as retrolisthesis.

Spondylolisthesis can cause a spine deformity and a narrowing of the spinal canal (central spinal stenosis) or compression of the leaving nerve roots (foraminal stenosis).

Spondylolisthesis is more common in the lower back (lumbar spine), but it can also occur in the upper-middle part of the back (thoracic spine) and the neck (cervical spine).

It becomes more apparent in people involved in physical activities such as lifting weights, gymnastics, or soccer.


Men are more likely than women to develop symptoms from the disorder, mainly because they participate in more physical activities.

Although some children under the age of five may be predisposed to having a spondylolisthesis or may already have an undetected spondylolisthesis, it is rare for these young children to be diagnosed with spondylolisthesis.

Spondylolisthesis becomes more common among children aged 7-10 years. The increase in physical activities of adolescence and adulthood, together with the erosion of daily life, results in spondylolisthesis being more common among adolescents and adults.


Spondylolisthesis was first described in 1782 by the Belgian obstetrician Herbinaux.

It is often defined in the literature as displacement in any direction.

However, medical dictionaries generally define spondylolisthesis specifically as the forward or anterior displacement of a vertebra over the inferior vertebra (or sacrum).

Olisthesis is a term that most explicitly denotes displacement in any direction.

The forward or anterior displacement can be specifically called anterolisthesis. Anterolisthesis commonly involves the fifth lumbar vertebra.

The backward movement is called retrolisthesis. Lateral displacement is called lateral listhesis or laterolisthesis.


A retrolistesis is a posterior displacement of a vertebral body concerning the underlying vertebra to a lesser degree than a dislocation.

Retrolistesis is more quickly diagnosed in lateral X-ray views of the spine. The pictures, where care has been taken to obtain an accurate lateral view without rotation, offer the best diagnostic quality.

The retrolistesis is found mainly in the cervical spine and the lumbar region but can also be seen in the thoracic area.

Classification of spondylolisthesis

It can be categorized by location and severity.

By location

The location of the sterolistesis includes which vertebrae are involved and can also specify which parts of the vertebrae are affected.

Isthmic anterolisthesis is where there is a defect in the pars interarticularis. The most common spondylolisthesis, also called spondylolysis spondylolisthesis, occurs with an informed prevalence of 5-7% in the US population. UU

A slip or fracture of the intravertebral joint is usually acquired between 6 and 16 but remains unnoticed until adulthood.

Approximately 90% of these isthmic slips are low grade (less than 50%), and 10% are high grade (mistakes greater than 50%). It is divided into three subtypes:

  • A: fatigue fracture by pairs.
  • B: elongation of pairs due to multiple effects of cured stress.
  • C: acute split of pars.


Slip severity is usually measured after taking a lateral vision radiograph and then classified on a scale of 1 to 5. Sliding is calculated from the amount by which the upper vertebral body slides forward over the body. Lower vertebral:

  • Grade I: is a glide of up to 0-25%.
  • Grade II: is between 25-50%.
  • Grade III: is between 50-75%.
  • Grade IV: it is between 75-100%.
  • Grade V: greater than 100% or spondylosis occurs when the vertebra has completely fallen off the next vertebra.

What are the symptoms?

Low back pain is the most common symptom of spondylolisthesis. This often worsens after exercise, especially with extension of the lumbar spine.

Other symptoms include hamstring stiffness and stiffness and decreased range of motion of the lower back. Pain in the legs, thighs, and buttocks can worsen when standing up.

Some patients may develop pain, numbness, tingling, or weakness in the legs due to nerve compression.

  • There is a general stiffness of the back and hardening of the hamstrings, with a resulting change in posture and gait.
  • Due to compensatory changes, you can observe a forward inclined or semichototic posture.
  • In more advanced cases, a “slow movement” can be seen due to the pelvis’s compensatory rotation due to the lumbar spine’s decreased process.
  • The change in gait is often a noticeable atrophy in the gluteal muscles due to lack of use.
  • Generalized lower back pain can also be seen, with intermittent pain from the buttocks to the back of the thigh and the lower part of the leg through the sciatic nerve.

Other symptoms may include tingling and numbness. Coughing and sneezing can intensify the pain.

  • Pain gets worse when standing, walking, or any activity involving leaning back.
  • Pain that feels better when sitting, especially in a reclined position.

An individual may also notice a “sliding sensation” when moving to a vertical position. Sitting and trying to stand can be painful and difficult.

What causes spondylolisthesis?

A single or repeated force applied to the spine can cause spondylolisthesis, for example, falling off a ladder and falling on its feet or the regular impact on the spine suffered by offensive linemen playing football.

Type I – dysplastic or congenital spondylolisthesis: dysplastic spondylolisthesis is caused by a defect in forming a part of the vertebra called a facet that allows it to slide forward. This is a condition with which a patient is born (congenital).

It is the result of congenital abnormalities and usually occurs in the area where the lumbar spine and the sacrum of the upper sacral facets or lower facets of the fifth lumbar vertebrae, the L5-S1 area, and represents between 14%. And 21% of all anterolisthesis.

Type II – Isthmic spondylolisthesis: in isthmic spondylolisthesis, there is a defect in a portion of the vertebra called pars interarticularis, a particular region of the vertebra. If there is a defect without a slip, the condition is called spondylolysis.

Isthmic spondylolisthesis is further divided:

Type II A: gymnasts, weightlifters, and soccer linemen are especially prone to spondylolisthesis. Multiple microfractures cause it in the pars interarticularis-microfractures due to hyperextension (general) and excessive use. The torque is completely fractured in type II-A.

Type II B: this type is also caused by microfractures. The difference, however, is that the pairs do not fracture completely. In contrast, new bones grow as the team heals and causes them to stretch. A longer couple can cause the vertebra to move forward.

Type II C: This type has a complete fracture like type II-A. However, it is caused by trauma. The impact of a car accident could fracture your peers, for example.

A fracture in pairs can lead to a moving piece of bone; the lower articular process detached can move.

Problems with the pars interarticularis can also be called spondylolysis. The word looks like spondylolisthesis, and they are somewhat related.

Microfractures in the pars interarticularis, of the type that gymnasts are prone to, football players, and weightlifters are a form of spondylolysis.

The fractures are called spondylolysis; If the vertebra slips forward because it is not held in place correctly, it is called spondylolisthesis.

Type III – Degenerative spondylolisthesis: degenerative spondylolisthesis occurs due to arthritic changes in the vertebrae joints due to cartilage degeneration and is acquired later in life.

It is a disease of the elderly that develops due to facet arthritis and joint remodeling. Joint arthritis and weakness of the yellow ligament can cause a vertebra to slip.

As you grow older, the parts of your spine may degenerate; They can wear out. Usually, their intervertebral discs change first.

The older they are, the less water content and proteoglycans have in the discs, and the less fluid makes them less able to handle movements and strokes.

Less fluid can also cause the disc to thin out, and a thinner disc brings the facet joints closer together. Degenerative forms are more frequent in women, people over fifty, and African-Americans.

Type IV – Traumatic spondylolisthesis: it is rare and is due to direct trauma or injury to the vertebrae. This can be caused by a fracture of the pedicle, lamina, or facet joints that allow the vertebra’s frontal portion to slide forward concerning the posterior part of the vertebra.

Similar to type II C, type IV involves a fracture.

Type V – Pathological spondylolisthesis: Pathological spondylolisthesis is caused by a defect in the bone caused by an abnormal bone, such as a tumor.

Type VI – Surgical spondylolisthesis: also known as iatrogenic spondylolisthesis, and is caused by a weakening of paresis, often as a result of a laminectomy (a routine back surgery, but type VI spondylolisthesis is not a typical result of surgery ).

As a quick summary, spondylolisthesis can be caused by:

  • A congenital disability
  • Fractures
  • Degeneration due to age or excessive use.
  • Tumors
  • Surgery.

Which are the risk factors?

The risk factors for spondylolisthesis include a family history of back problems. People born with a defect in the pars interarticular spine (a condition called spondylolysis) have an increased risk of isthmic spondylolisthesis.

Other risk factors include a history of repetitive trauma or hyperextension of the lower back or lumbar spine.

Athletes such as gymnasts, weightlifters, and soccer linemen who have great forces applied to the spine during extension have a greater risk of developing isthmic spondylolisthesis.

What types of doctors treat spondylolisthesis?

Radiologists diagnose spondylolisthesis with X-rays, CT scans, or MRIs.

Orthopedic surgeons, specialized neurosurgeons in the spine, physical medicine and rehabilitation physicians, neurologists, internists, primary care providers, and rheumatologists often treat spondylolisthesis.

Chiropractors and physiotherapists also frequently treat patients with spondylolisthesis.


It is difficult to know if you have spondylolisthesis because you may not have any symptoms or overwhelming pain; Most people do not.

Spondylolisthesis is usually discovered when tested for something else, and the doctor notices the vertebrae slipped on an x-ray.

They will inject a particular contrast medium into the area around the nerves; the nerves are in a sac, so the dye will get into that sac. Spondylolisthesis can cause it to walk abnormally, so the doctor may have to monitor it.

Skid qualifications

Using the lateral radiograph, your doctor will evaluate your spondylolisthesis. You will use the scale from grade I to grade V that describes how far your vertebra has slipped.

How do doctors diagnose spondylolisthesis?

It is impossible to see visible signs of spondylolisthesis when examining a patient.

Simple radiographs quickly make the diagnosis of spondylolisthesis. A lateral X-ray (from the side) will show if one of the vertebrae has slid forward compared to the adjacent vertebrae.

Spondylolisthesis is classified according to the vertebra sliding percentage of the neighboring vertebra.

If the patient has complaints of pain, numbness, tingling, or weakness in the legs, additional studies may be requested. These symptoms can be caused by stenosis or narrowing of the space for the nerve roots of the legs.

A CT scan or magnetic resonance imaging can help identify nerve compression associated with spondylolisthesis.


The initial treatment for spondylolisthesis is conservative and is based on the symptoms.


Patients with symptomatic isthmic anterolistesis are initially offered a conservative treatment consisting of activity modification, pharmacological intervention, and a physiotherapy consultation.

A short rest period or avoiding activities such as lifting, leaning, and athletics can help reduce symptoms.


Physical therapy can assess and address postural and compensatory movement abnormalities.

Patients with isthmic spondylolisthesis may benefit from a hyperextension orthopedic device (lumbosacral orthosis). Still, they should be used temporarily to prevent spinal muscle atrophy and loss of proprioception.

This extends the lumbar spine, bringing the two parts of the bone closer to the defect, and may allow healing—applying heat and ice to reduce localized pain.

For several reasons, exercises for spondylolisthesis are often incorporated into the treatment plan for these conditions.

On the one hand, physical therapy focuses on strengthening and improving the range of movement of the back, abdomen, and legs, as this can help these other muscle groups take part in the stress usually placed on the vertebral spine.

Spondylolisthesis treatment exercises can also benefit weight loss since excess pounds increase stress on the back.


Anti-inflammatory medications in combination with paracetamol (Tylenol) can be tested initially. If a severe radicular component is present, it can be considered a short treatment with oral steroids such as prednisone or methylprednisolone.

Home remedies for spondylolisthesis are similar to those for low back pain and include ice, heat, and over-the-counter pain relievers, such as acetaminophen and anti-inflammatory medications.

Epidural steroid injections, either interlaminar or transforaminal, performed under fluoroscopic guidance can help with severe radicular (leg) pain. To relieve the patient’s pain, you can inject lidocaine and steroids for a diagnostic study.


Surgery may be an option for those whose symptoms do not improve with conservative treatment.

Degenerative anterolisthesis with spinal stenosis is one of the most common indications for spine surgery (usually a laminectomy) among older adults. Both minimally invasive and open surgical techniques are used to treat anterolisthesis.

This involves removing any scar tissue from the defect and placing some bone grafts in the area, followed by the placement of screws through the fault.

There is an increased risk of nerve injury when moving the vertebra to the normal position. The results and recovery after surgery are improved with physical therapy rehabilitation.

The surgeon may also recommend a spinal fusion made from the front of the spine simultaneously.

Spondylolisthesis exercises for pain and back relief

After a thorough evaluation, your physiotherapist will be able to provide you with a personalized program of exercises at home to help decrease pain due to spondylolisthesis.

This program often includes lumbar flexion exercises, central stabilization exercises, and exercises or stretches for the back, hamstrings, and hips muscles.

Low-impact exercise such as biking or swimming is also recommended to promote healing and reduce pain.

Usually, doctors prescribe exercises to strengthen the abdomen and back muscles and increase the flexibility of the joints, which helps prevent and rehabilitate the severe type of low back pain.

Maintaining daily activities with a tolerable limit can help achieve a faster recovery in spondylolisthesis rather than resting in bed. These are the best exercises for spondylolisthesis:

  1. Pelvic tilt exercise

Lie on your back with knees bent and feet flat on the floor. Pull your belly button towards your spine and push the lower part of your back towards the bottom, flattening your back. Hold for 15 seconds, and then relax. Repeat five to ten times.

  1. Gluteal stretching exercise

Lie on your back with your knees bent. Lift one knee, gently pull it towards your chest for 10-15 seconds, and relax. Repeat five to ten times for each side.

  1. Bridge exercise

Lie on your back with both knees around 90 degrees. Then push the feet on the ground, squeeze the buttocks, and lift the hips off the floor until the shoulders, hips, and knees are straight.

Hold it for about 5 seconds, and then slowly lower your hips down to the floor and rest for up to ten seconds. Repeat ten times

  1. Backstretch exercise

Lie on your back, hands on your head. Bend your knees and turn them slowly to the side, keeping your feet on the floor. Hold for 10 seconds. Repeat three times on each side.

  1. Deep lunge exercise

Kneel on your knee, the other foot in front. Looking forward, raise the knee back. Hold for 5 seconds. Repeat three times on each side.

  1. Winding exercise (partial)

Lie on your back with knees bent and feet flat on the floor. Do not press the neck or lower back against the floor. Next, squeeze the abdomen and fold it halfway, keeping the head aligned with the shoulders. Hold this for 5 seconds. Unroll to lie down. Repeat three sets of 10.

  1. Knees to the chest

Lie on your back, bring both knees to your chest and then pull on your knees as much as possible. Hold for 10-20 seconds, and return your legs to the floor. Do the exercise about ten times. You can do this exercise with one or both legs once.

  1. Side table exercise

Lie on your right/left side with your legs straight. Get comfortable with your right forearm so that your body forms a diagonal line.

Rest your left hand on your hip. Secure your abs and hold for 1 minute or 30 seconds. Make sure your hips and knees do not touch the floor.

  1. Arm and leg exercise

Put on your hands and knees. Tighten the abdominals to harden the spine. When keeping your abdominal muscles firm, lift one arm and the other leg away from you.

Hold this position for 5 seconds. Slowly lower your arm and leg and alternate the sides. Do this ten times on each side.