Spondylolisthesis: what is it?

By Cristiano Antonino Last updated Jun 18, 2023

The medical term spondylolisthesis refers to a pathological condition characterised by a slow but progressive and constant displacement of a vertebra with respect to the vertebra underneath

The vertebrae most commonly affected by spondylolisthesis are the lower lumbar vertebrae, in particular the fourth and fifth lumbar vertebrae – L4 and L5 – and the first sacral vertebra – S1 -.

This ‘slippage’ can occur forward in relation to the underlying vertebra, in which case we are dealing with anterolisthesis; it can occur posteriorly in relation to the lower vertebra, in which case we are dealing with retrolisthesis; it can occur laterally in relation to the lower vertebra, in which case we are dealing with laterolisthesis.

Most cases of spondylolisthesis are in reality anterolisthesis: the forward slippage of the vertebra with respect to the one below is by far the most common.

Spondylolisthesis – depending on the severity with which it manifests itself, i.e. the percentage of vertebral body length involved – can be classified as follows

grade I spondylolisthesis: 0 to 25 per cent
Grade II spondylolisthesis: 25 to 50%.
Grade III spondylolisthesis: 50 to 75%.
grade IV spondylolisthesis: 75 to 100%

Symptoms with which spondylolisthesis manifests itself

As in most pathologies involving the spinal column, the symptoms experienced by the patient are directly proportional to the extent of the pathology: the more severe and evident the pathology is, the more the symptoms will – unfortunately – be accentuated.

The symptoms most commonly complained of by patients diagnosed with spondylolisthesis are

low back pain, further aggravated by physical exertion
coccyx pain
sore legs
back pain
paresthesia
joint stiffness
back and neck muscle stiffness
sciatica
Lhermitte’s sign
muscle spasms
vertebral stenosis

If the spondylolisthesis causes compression of nerves, the pain may also radiate to other parts of the body: following the course of the sciatic nerve – for example – severe pain may be felt in the buttock and the entire leg.

If, on the other hand, the spinal cord is compressed, there is a real risk of neurological deficits.

Spondylolisthesis: What causes it and who suffers from it?

There can be several causes of spondylolisthesis.

It could be caused by previous spondylolisthesis, i.e. a rupture between the body and the upper arch of the vertebra; it could be caused by deterioration of the vertebra and its disc; by trauma to the spine; or by infections, such as Pott’s disease, also known as tubercular spondylitis or spinal tuberculosis.

All these causes, as one can easily imagine, are of acquired and secondary origin.

Spondylolisthesis can also be congenital.

Those who suffer the most from the disorders associated with spondylolisthesis are especially women over the age of 40, who – during the menopause period – see their bone components weaken due to the phenomenon of osteoporosis, which can cause the vertebrae to slide apart.

Age-related body degeneration, as well as a good dose of genetic predisposition, is the major risk factor contributing to the development of spondylolisthesis.

Young people also suffer from spondylolisthesis, particularly young athletes who – due to overload, severe trauma, or a stress fracture – suffer a serious weakening of the lumbar elements.

Diagnosis of spondylolisthesis

The injury caused by spondylolisthesis is – in most cases – latent, which is why, as a rule, this condition is discovered almost by chance.

Treatments: the most appropriate for spondylolisthesis

In addition to being treated with pain-relieving and anti-inflammatory drugs to alleviate the painful symptoms that most often accompany spondylolisthesis, it will be necessary – under the advice of the physiotherapy specialist – to follow a therapy with re-educational techniques in the gym.

This is because drug therapy alone only alleviates the symptoms, without being able to cure the primary cause of the problem.

The muscular strengthening exercises that must be performed in the gym must – as a first and fundamental thing – eliminate or reduce to a minimum the weight discharges on the spinal column; one would otherwise risk further aggravating the already existing problem.

Similarly, exercises that accentuate lumbar hyperlordosis – the inward arching of the back – will also be strongly discouraged.

To improve the spondylolisthesis situation, exercises aimed at strengthening the stabilising muscles of the pelvis, abdominal muscles, ischiocrural muscles and buttocks will be prescribed instead.

It will also be important to further strengthen the oblique muscles of the abdomen.

All these exercises, which – as can be easily observed – involve the central part of the body, are only aimed at creating a sort of ‘rigid corset’ that keeps the lumbar vertebrae in place.

The more this area is trained, the less noticeable and painful the spondylolisthesis will be.

Alongside muscle strengthening, a postural re-education course will also be recommended through which, thanks to exercises specifically aimed at controlling and stabilising the pelvis, an attempt will be made to restore the subject to the most favourable position for maintaining a healthy and correct spinal alignment.

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