Spondylolisthesis

Condition Basics

What is spondylolisthesis?

In spondylolisthesis, one bone in your back (vertebra) slides forward over the bone below it. It most often occurs in the lower spine (lumbosacral area). In some cases, this may lead to your spinal cord or nerve roots being squeezed. This can cause back pain and numbness or weakness in one or both legs. In rare cases, it can also lead to losing control over your bladder or bowels. See a doctor right away if you begin losing bladder or bowel control.

Sometimes when a vertebra slips out of place, you may have no symptoms at all or no symptoms until years later. Then you may have pain in your low back or buttock. Muscles in your leg may feel tight or weak. You may even limp.

What causes it?

Spondylolisthesis may be caused by problems with the small joints in your back. (The problems are called spondylolysis.) You could have:

• A defective joint that you've had since birth (congenital).
• A joint damaged by an accident or other trauma.
• A vertebra with a stress fracture caused from overuse of the joint.
• A joint damaged by an infection or arthritis.

Spondylolisthesis affects children and teens who play sports. Some sports, such as gymnastics or weight lifting, can overuse back bones to the point of causing stress fractures in vertebrae, which can result in the condition.

Older adults can develop spondylolisthesis because wear and tear on the back leads to stress fractures. It can also occur without stress fractures when the disc and joints are worn down and slip out of place.

What are the symptoms?

Symptoms of spondylolisthesis may include:

• Back or buttock pain.
• Pain that runs from the lower back down one or both legs.
• Numbness or weakness in one or both legs.
• Difficulty walking.
• Leg, back, or buttock pain that gets worse when you bend over or twist.
• Loss of bladder or bowel control, in rare cases.

Sometimes spondylolisthesis causes no symptoms at all.

How is it diagnosed?

To check for spondylolisthesis, your doctor will ask questions about your symptoms and do an exam. If your doctor suspects spondylolisthesis, they will probably do X-rays. You could also have a CT scan or an MRI done.

How is spondylolisthesis treated?

Treatment for spondylolisthesis begins with stopping any physical activity that may have led to vertebrae damage or that increases pain. For pain, your doctor may suggest taking NSAIDs. These include ibuprofen (such as Advil) or naproxen (such as Aleve). Or use acetaminophen (such as Tylenol) for pain.

Doctors often suggest physical therapy to build up stomach and back muscles (core strengthening). Losing weight, if you need to, may also help.

Surgery may help if the pain is extreme, the bones continue to move, or you have nerve root or spinal cord damage from the condition. This takes pressure off the spinal cord or nerves (decompression). Or the bones may be fused in position. Sometimes both decompression and fusion are done during the same surgery.

After any of these surgeries, you may need to wear a cast or back brace for a while. Later, rehabilitation therapy will help make your muscles stronger and your movement easier.