Degenerative Lumbar Spondylolisthesis: Symptoms, Diagnosis, and Treatment

What Is Degenerative Lumbar Spondylolisthesis?

As the discs and joints of the lower back change with age, one vertebra may gradually shift forward relative to the vertebra below it. This condition is called degenerative lumbar spondylolisthesis.

In some patients, this slippage can narrow the space around nearby nerves, leading to a condition called spinal stenosis.

Although spondylolisthesis may sound concerning, many people have this condition without significant symptoms. Others may experience pain, weakness, or difficulty with everyday activities.

What Are the Symptoms?

Symptoms can vary depending on whether the slipped vertebra is placing pressure on nearby nerves.

Common symptoms include lower back pain, pain traveling into the buttocks or legs, numbness, tingling, and leg weakness. 

Some patients develop difficulty standing or walking for extended periods. They may notice that their legs feel heavy, tired, or painful after walking a certain distance, with relief when sitting or leaning forward.

Importantly, the amount of slippage seen on an X-ray does not always reflect the severity of a patient’s symptoms.

How Is Spondylolisthesis Diagnosed?

Diagnosis begins with a discussion of your symptoms, medical history, and a physical examination.

Standing X-rays can identify the slipped vertebra. Additional X-rays taken while bending forward and backward may help determine whether there is abnormal movement between the bones.

An MRI may also be recommended to evaluate the nerves and identify areas of spinal stenosis or nerve compression.

The most important part of the evaluation is determining whether the findings on your imaging explain the symptoms you are experiencing.

What Are the Treatment Options?

Treatment depends on your symptoms, physical examination, imaging findings, and how much the condition affects your daily life. 

For patients with mild or manageable symptoms, nonsurgical treatment is often a reasonable starting point. This may include physical therapy, activity modifications, anti-inflammatory medications, or spinal injections.

Although these treatments do not reverse the slippage, they can help reduce pain and improve function.

However, nonsurgical treatments are not always enough, particularly when nerve compression causes persistent pain, weakness, or difficulty walking.

When Can Surgery Help?

For patients whose symptoms continue despite appropriate nonsurgical treatment, surgery can offer meaningful and lasting improvement.

Patients with significant nerve compression may experience substantial relief of leg pain, improved walking tolerance, and a return to activities that had become difficult or impossible.

Research has demonstrated that appropriately selected patients undergoing surgery for symptomatic degenerative spondylolisthesis can experience greater improvements in pain and physical function than those treated without surgery.

Surgery may also be recommended when neurological weakness is worsening or when symptoms significantly interfere with daily activities.

The goal of surgery is not simply to correct an abnormal X-ray. It is to address the underlying problem and improve your quality of life.

What Does Surgery Involve?

Surgery generally focuses on relieving pressure on compressed nerves and, when necessary, stabilizing the spine.

A procedure called a decompression creates additional space for the nerves. In some patients, this may be sufficient to improve symptoms.

Other patients may benefit from a spinal fusion, which stabilizes the affected bones and prevents painful or abnormal movement.

Not every patient with spondylolisthesis requires a fusion. The decision depends on several factors, including spinal stability, the location of nerve compression, and individual anatomy.

Both procedures can provide significant benefits when appropriately selected. However, as with any operation, there are potential risks, and the degree of improvement varies between patients.

When Should You Seek Medical Attention?

New or worsening leg weakness should be evaluated promptly.

New difficulty urinating, loss of bowel or bladder control, or numbness around the groin may indicate serious nerve compression and requires immediate emergency evaluation.

My Approach to Spine Care

I believe successful spine care begins with understanding the source of a patient’s symptoms and how those symptoms affect everyday life.

Not every abnormality on an MRI requires surgery. However, when nerve compression, pain, or weakness significantly limits a patient’s quality of life, surgery can be an effective and lasting treatment option.

My goal is to provide patients with a clear understanding of their condition, explain the available treatment options, and recommend an approach that best addresses their individual needs.

Whether treatment involves physical therapy, injections, or surgery, the focus remains the same: improving pain, restoring function, and helping patients return to the activities that matter most to them.

Medical References

1.    American Academy of Orthopaedic Surgeons (AAOS). Adult Spondylolisthesis of the Low Back. OrthoInfo.
2.    Abdu WA, et al. Long-Term Results of Surgery Compared With Nonoperative Treatment for Lumbar Degenerative Spondylolisthesis in the Spine Patient Outcomes Research Trial (SPORT). Spine. 2018;43(23):1619–1630. doi:10.1097/BRS.0000000000002682.
3.    Kgomotso EL, et al. Decompression Alone or With Fusion for Degenerative Lumbar Spondylolisthesis (Nordsten-DS): Five-Year Follow-up of a Randomised, Multicentre, Non-Inferiority Trial. BMJ. 2024;386:e079771. doi:10.1136/bmj-2024-079771.