Spondylolisthesis (Slipped Vertebra)
What Is Spondylolisthesis?
Spondylolisthesis, also called slipped vertebra or shifted spine, occurs when a vertebra in the spine slips forward or backward from its correct position in relation to other vertebrae, usually in the lower back. This slippage can result from various underlying conditions and can lead to spinal instability, nerve compression, and significant pain.
The condition can be caused by a vertebra being defective from birth, breaking due to a stress fracture or trauma, or discs degenerating from disease, infection, or aging. A fracture or defect in part of the vertebra, called spondylolysis, can cause the vertebra to slip forward, backward, or side-to-side over the vertebra below.
Spondylolisthesis occurs due to multiple underlying conditions, but the two most common types are spondylolytic spondylolisthesis and degenerative spondylolisthesis. Spondylolytic spondylolisthesis is more common in younger people, especially athletes, and is usually developed early on and present throughout life. Degenerative spondylolisthesis generally affects people over age 60, occurring due to the natural spinal degeneration process that accompanies aging.
Common symptoms include muscle weakness, numbness, tightness, and stiffness in the back and legs, lower back pain, pain in the buttocks or hips, pain extending down through the legs or other extremities due to pressure on nerve roots, and sciatica. In some cases, spondylolisthesis can cause weakness in the lower extremities, including the feet, a condition known as foot drop. Degenerative spondylolisthesis can be particularly debilitating, with symptoms including those commonly associated with a pinched spinal nerve and, in severe cases, an inability to walk due to pain.
Nonsurgical Treatments
Many cases of spondylolisthesis can be effectively managed without surgery. Diagnosing the condition in its earlier stages can help prevent more serious symptoms in the future and allow for less invasive treatments. Our doctors offer a range of nonsurgical treatments to help relieve pain, improve mobility, and protect long-term spinal health. Depending on severity, treatment may include medication, physical therapy, techniques for managing pain, or supportive devices. If the condition is non-symptomatic, a patient may choose to monitor the condition without active treatment.
Lifestyle Modifications
Early diagnosis and lifestyle adjustments are crucial for managing spondylolisthesis and preventing progression. Activity modifications are essential, particularly for patients with spondylolytic spondylolisthesis. This may include avoiding high-impact activities, sports that involve hyperextension of the back, and movements that increase stress on the affected vertebrae.
For patients with degenerative spondylolisthesis, maintaining a healthy weight can reduce stress on the spine and slow the progression of the condition. Proper body mechanics during daily activities, such as lifting techniques and posture awareness, are also important. Patients should avoid prolonged sitting or standing in one position and incorporate regular, gentle movement throughout the day to maintain spinal flexibility and strength.
Medications & Injections
Medications play an important role in treating spondylolisthesis symptoms. Over-the-counter anti-inflammatory drugs such as ibuprofen (Advil) can help reduce inflammation and manage pain. It's important to consult with your pharmacist or doctor before starting any anti-inflammatory medications, as they may interact with other medications or be contraindicated for certain medical conditions.
For more significant pain or when oral medications are not sufficient, epidural steroid injections can provide substantial relief. These injections deliver powerful anti-inflammatory medication directly to the affected area, reducing swelling around compressed nerves and providing pain relief that can last for weeks or months. Your orthopedic doctor may recommend a series of injections as part of a comprehensive strategy to manage pain.
Physical & Occupational Therapy
Physical therapy is a cornerstone of nonsurgical treatment for spondylolisthesis. Treatment approaches include therapeutic massage to relieve muscle tension and spasms, core-strengthening exercises to stabilize the spine and support the affected vertebrae, and flexibility exercises to maintain range of motion. Specific exercises focus on strengthening the abdominal and back muscles to provide better spinal support and reduce stress on the slipped vertebra. Traction therapy may also be used to gently stretch the spine and relieve pressure on compressed nerves. A physical therapist will develop a customized program tailored to your specific type of spondylolisthesis, severity of symptoms, and functional goals.
Supportive & Assistive Devices
Spinal support devices, particularly back braces, can be beneficial in managing spondylolisthesis. A back brace helps limit motion in the lower spine, reducing stress on the affected vertebra and providing stability to prevent further slippage. The type of brace and duration of use will depend on the severity of the condition, the patient's age, activity level, and treatment goals. Some patients may need to wear a brace during activities, while others may benefit from more continuous use. Your orthopedic doctor will determine the most appropriate bracing strategy for your specific needs.
Surgical Treatments
When nonsurgical options are no longer effective or the condition causes severe symptoms that significantly impact quality of life, surgery may offer lasting pain relief and improved function. The right surgical approach depends on your age, activity level, the degree of vertebral slippage, the presence of nerve compression, and overall spinal stability.
Decompression Surgery
For patients experiencing nerve compression due to spondylolisthesis, decompression surgery may be performed to relieve pressure on the spinal nerves. This procedure involves removing bone, disc material, or other tissue that is pressing on the nerves. Decompression surgery can be performed through minimally invasive techniques in many cases, resulting in less tissue damage, reduced postoperative pain, and faster recovery. The procedure aims to alleviate symptoms such as leg pain, numbness, and weakness caused by compressed nerves.
Spinal Fusion
Spinal fusion is often necessary for spondylolisthesis to stabilize the affected segment and prevent further slippage. This procedure permanently joins two or more vertebrae together to eliminate motion at the affected level. During the surgery, bone graft material is placed between the vertebrae, and hardware such as screws, rods, and plates is used to hold the vertebrae in proper alignment while the fusion heals. While spinal fusion limits motion at the fused segment, it provides excellent stability, can prevent progression of the slippage, and significantly reduces pain and neurological symptoms. The procedure may be combined with decompression surgery if nerve compression is present.
Minimally Invasive Fusion Techniques
Advances in surgical techniques have made it possible to perform spinal fusion procedures using minimally invasive approaches for select patients. These techniques use smaller incisions, specialized instruments, and advanced imaging to achieve the same fusion goals as traditional open surgery while causing less disruption to surrounding muscles and tissues. Minimally invasive fusion typically results in less postoperative pain, shorter hospital stays, faster recovery, and smaller scars. Your surgeon will evaluate whether you are a candidate for minimally invasive techniques based on your specific anatomy and the complexity of your condition.