Spondylolisthesis is a condition of the spine in which a vertebra slips out of alignment, moving forward on the vertebra below. The condition is usually caused by degenerative disease, such as arthritis. Other causes include bone diseases, trauma, and stress fractures, which may occur during sports that put a lot of pressure and stress on the back or overstretch the spine. Gymnasts, weight-lifters, and football players are at increased risk. Spondylolisthesis can also result from a congenital disorder of the spine.
At UPMC, we begin with conservative treatments such as medications to alleviate pain and physical therapy to stabilize the spine. Most patients experience relief from pain within a month or two with conservative treatment. However, if the vertebra continues to slip or if pain continues after conservative treatment, our neurosurgical team may recommend surgery such as decompression laminectomy or spinal fusion.
To diagnose spondylolisthesis, the doctor will perform a physical exam and medical history. Spondylolisthesis can produce increased lordosis (swayback) or kyphosis (roundback). In many cases, patients experience no obvious symptoms, but symptoms may include:
The doctor may order an MRI, CT scan or x-ray to show if a vertebra is out of place and if any fractures have occurred.
Treatment for spondylolisthesis varies depending on how severe the symptoms are. At UPMC, we usually begin with physical therapy. Many patients see improvement with stabilization, strengthening and stretching exercises. Over-the-counter pain medication such as non-steroidal anti-inflammatory drugs (NSAIDs) may be prescribed to alleviate pain and reduce inflammation. Epidural steroid injections can provide relief from pain if over-the-counter medications don’t work.
If the patient’s symptoms are not relieved by conservative treatments, surgery might be recommended. A decompression laminectomy removes bony spurs in the spinal canal, freeing up space for the nerves and spinal cord. Spinal fusion is a technique in which two vertebrae (back bones) are fused together. This provides stronger support for the spine, and is almost always done after decompression laminectomy.
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