Spondylolisthesis is where one of the bones in your spine, known as a vertebra, slips out of position.
It's most common in the lower back, but it can also happen in the mid to upper back or at the top of the spine at the back of your neck.
Spondylolisthesis is not the same as a slipped disc. A slipped disc is when a disc (the tissue between the bones in your spine) moves out of place.
Symptoms of spondylolisthesis
Many people may not realise they have spondylolisthesis because it does not always cause symptoms.
Symptoms can include:
- lower back pain – which is usually worse when you're active or when you're standing, and is often relieved by lying down
- pain, numbness or a tingling feeling spreading from your lower back down your legs (sciatica) – this happens if the bone in the spine presses on a nerve
- tight hamstring muscles
- stiffness or tenderness in your back
- curvature of the spine (kyphosis)
The severity of these symptoms can vary from person to person.
What causes spondylolisthesis?
Spondylolisthesis can be caused by:
- a birth defect in part of the spine – this can cause it to slip forward
- repetitive trauma to the spine – this results in a defect developing in the spine, which can cause it to slip; it's more common in athletes such as gymnasts and weightlifters
- the joints of the vertebrae becoming worn and arthritic – this is more common in older people
- a sudden injury or trauma to the spine – such as a fracture, which can result in the vertebra slipping forward
- a bone abnormality – this can be caused by a tumour, for example
When to see your GP
See your GP if:
- you have persistent back pain or stiffness
- you have persistent pain in your thighs or buttocks
- your back curves outwards
Your GP may examine your back, although there are not usually any visible signs of spondylolisthesis.
Your GP may ask you to do a straight leg raise test, where you lie on your back while your GP holds your foot and lifts your leg up, keeping your knee straight. This is often painful if you have spondylolisthesis.
Spondylolisthesis can easily be confirmed by taking an X-ray of your spine from the side while you're standing.
This will show whether a bone in your spine has slipped out of position or if you have a fracture.
These more detailed scans will be able to help work out whether you have a compressed nerve in your back.
The way spondylolisthesis is treated depends on your symptoms and how severe they are.
In most cases, non-surgical treatments will be recommended first.
Initial treatments for spondylolisthesis may include:
- a short period of rest, avoiding activities such as bending, lifting, contact sports and athletics
- anti-inflammatory painkillers, such as ibuprofen, or stronger painkillers available on prescription
- physiotherapy – simple stretching and strengthening exercises may help increase the range of motion in your lower back and hamstrings
- if you have pain, numbness and tingling in your legs, corticosteroid injections around the compressed nerve and into the centre of your spine may be recommended
These treatments only provide temporary relief, but your symptoms may disappear completely with time.
Back braces used to be recommended for some people with spondylolisthesis, but they're no longer used because there are concerns that they may weaken your spine without improving symptoms.
Back surgery for spondylolisthesis
Surgery may be recommended if non-surgical treatments do not work and your symptoms are severe, persistent or suggest you have a compressed nerve in your spine.
The type of operation you need depends on the type of spondylolisthesis you have.
The surgery usually involves fusing the slipped bone in your spine to the bones next to them using metal screws and rods, and a piece of your own bone taken from an area nearby. The screws and rods are usually left in place permanently.
In some cases, the disc between the bones in your spine may also be removed. It'll be replaced by a small "cage" containing a bone graft to hold the bones in your spine apart.
The operation is performed under general anaesthetic, which means you will not be awake.
Surgery often relieves many of the symptoms of spondylolisthesis, particularly pain and numbness in the legs.
But it's a major operation that involves up to a week in hospital and a recovery period lasting months, where you have to limit your activities.
Spinal surgery for spondylolisthesis also carries a risk of potentially serious complications.
- infection at the site of the operation
- a blood clot developing in one of the veins in your leg (deep vein thrombosis, or DVT)
- damage to the spinal nerves or spinal cord, resulting in continuing symptoms, numbness or weakness in the legs, or, in rare cases, some paralysis or loss of bowel or bladder control
Because of the possibility of complications, make sure you discuss the operation in detail with your doctor or surgeon before deciding to have surgery.
Read more about lumbar decompression surgery, a type of spinal surgery used to treat compressed nerves in the lower (lumbar) spine.