Spondylolisthesis is a spinal condition where a vertebra bone slips forward on to the bone below it.

Spondylolisthesis is a spinal condition in which the vertebrae are misaligned leading to pain. In most cases, the problem can be treated either using therapeutics or by using surgical methods. 

There can be multiple types of spondylolisthesis as mentioned below

  • Congenital spondylolisthesis – Defective spine formation at birth increases the risk of slippage at a later age.
  • Isthmic spondylolisthesis – This condition develops due to spondylolysis. Fracture in the bones can weaken it further.
  • Degenerative spondylolisthesis – This condition is most commonly found and develops at a later age. The vertebrae become more mobile with changes in the joints, and this increases the chances of slippage.

Spondylolisthesis Symptoms

The main symptoms are of back pain and leg pain. The associated back pain is typically worse when in a stationary position. The pain of this condition results from the instability at the level of spondylolisthesis.  When the vertebra slips forward it causes narrowing of the spinal canal. It can also compress the nerve foramina. This can result in the following symptoms:

  • shooting pain down the leg
  • numbness or tingling
  • difficulty walking significant distances

Causes of Spondylolisthesis

There can be multiple causes of the disease including the age, genetics and lifestyle. The condition can develop in children due to a defect or injury since birth. This condition may also arise during adolescence due to rapid growth. 

The more common cause is progressive ageing of the spine. This results in what is called degenerative spondlolisthesis

Certain sports, such as football, field sports, gymnastics and weightlifting put pressure on the lower back. This can increase the chances and prevalence of spondylolisthesis. 

Risk Factors

  • Defective interarticularis bone in the spine from birth is the major risk factor for isthmic spondylolisthesis
  • Patient with a family history of spondylolisthesis
  • Hyperextension of the lumbar spine
  • Continuous trauma
  • Athletes such as gymnast and weight lifters, are at an increased risk of getting isthmic spondylolisthesis.


One of the major complications related to spondylolisthesis is a long-lasting pain in the lower back or deep down the legs. This is accompanied with with weakness, prickling and numbness in the legs. Severe constriction of the nerves leads to problems in the bowel or bladder in rare cases. 

Spondylolisthesis Diagnosis

Usually, spondylolisthesis is diagnosed when patients present with symptoms of back pain or leg pain. The radiological investigations that help confirm the diagnosis include x-rays, CT scans of the spine and MRI scans.

  • The MRI scan provides information on the extent of the spinal canal and nerve narrowing.
  • The CT scans are used to understand the bony anatomy and to look for the bony pars defect.
  • Static and dynamic X-rays are performed to look for instability in the spine.

Spondylolisthesis Treatment

The treatment options depend on the extent of spondylolisthesis and the symptoms it causes.  Conservative treatment is prescribed for patients who have very mild spondylolisthesis and intermittent back pain. Non-surgical treatment involves pain killers, weight loss and physiotherapy or hydrotherapy. These are the best forms of  supportive treatment.

Surgical treatment may be a consideration when:

  • Patients do not respond to conservative treatment
  • The patient’s symptoms are progressively worsening
  • Patients have symptoms of neural compression including numbness, weakness or difficulty walking

Surgical Treatment

The goal of surgical treatment is to decompress the spinal canal and spinal nerves. It also aims to bring stability to the spine. Stabilisation is achieved by inserting pedicle screws or rods and performing interbody fusion.  The interbody fusion component of this operation uses multiple techniques.

Depending on anatomical constraints, the options of spinal fusion are:

  • Posterior lumbar interbody fusion (PLIF)
  • Transforaminal lumbar interbody fusion (TLIF)
  • Lateral lumbar interbody fusion (LLIF)
  • Anterior lumbar interbody fusion (ALIF)

The team at Neuroaxis have experience performing all the above spinal fusion options. The choice of surgery is usually guided by a combination of factors. This includes a careful analysis of the patient’s scans and understanding the anatomical limitations if any.

The vast majority of these fusions are performed using keyhole surgery techniques. The spinal fixation part of the operation is commonly performed using robotic spine surgery or using navigation techniques.

In the case of an anterior lumbar interbody fusion, an experienced vascular surgeon will assist the operation.

Transforaminal lumbar interbody fusion (TLIF)

Posterior lumbar interbody fusion (PLIF)

Lateral lumbar interbody fusion (LLIF)

Anterior lumbar interbody fusion (ALIF)

Frequently asked patient questions

How to treat spondylolisthesis?

Spondylolisthesis can be treated by:

  • restricting physical activity
  • using pain and inflammation relievers
  • wearing a brace support for the spine
  • physical therapy.

These all help to manage and control the symptoms if surgery is not indicated.

The definitive treatment in indicated cases is to have surgery. The surgical treatment in most cases involve some variety of spinal fusion. The type of spinal fusion depends on the location of the misalignment amongst other clinical and anatomical factors.

Is a brace required post surgery?

Yes, it is in most cases. The patients are advised to wear the brace for three to six months. This aids in the healing process by supporting the spinal cord.

What leads to spondylolisthesis?

Various factors can cause spondylolisthesis such as:

  • pars articularis defects
  • stress or force, which may lead to breaking of a bone and ultimately slippage of vertebra
  • degenerative processes of the spine
  • a late complication following a laminectomy procedure

Do I need to go for surgery for spondylolisthesis?

The surgery requirements depends on the seriousness of the spondylolisthesis. The surgery is often preferred when the non-surgical options are not working and symptoms do not improve.