• Back Pain

Spondylolisthesis: Causes, Symptoms, and Treatment

Published: May 29, 2025
Updated: May 29, 2025
4 mins

Spondylolisthesis is a condition where one of the bones in your spine slips forward over the one below it. This slippage can cause anything from mild back pain to more serious issues if it starts pressing on nearby nerves. While spondylolisthesis can happen anywhere along the spine, it’s most common in the lower back (lumbar spine), which handles a lot of your body’s weight and movement.

Catching spondylolisthesis early is important because it gives you the best chance to manage symptoms and keep things from getting worse. Whether it’s a nagging backache or more noticeable nerve-related pain, recognizing the signs early can help guide effective treatment and keep you active.

What is Spondylolisthesis?

Spondylolisthesis is a condition where one of the bones in your spine – a vertebra – slips out of its normal position and moves forward over the bone beneath it. This slippage can put pressure on nearby nerves and cause pain, stiffness, or other symptoms.

The most common place for this to happen is in the lower back, a region known as the lumbar spine. When spondylolisthesis occurs here, it’s called lumbar spondylolisthesis. People with lumbar spondylolisthesis may feel lower back pain that sometimes radiates into the legs, especially if nerves are affected.

While spondylolisthesis most often affects the lumbar region, it can occasionally happen higher up in the spine, such as in the neck (cervical spine) or mid-back (thoracic spine), though these cases are much less common.

Types of Spondylolisthesis

Isthmic spondylolisthesis

Isthmic spondylolisthesis happens when a small fracture develops in a part of the vertebra called the pars interarticularis. This tiny bone segment acts like a bridge between joints in the back of the spine, and when it cracks – usually due to repetitive stress – the vertebra can begin to slip out of place. 

This type most often affects teens and young adults, especially those involved in sports that put repeated strain on the lower back, like gymnastics, football, or weightlifting. These are often referred to as "sports-related stress fractures," and over time, they can lead to slippage even if symptoms don’t show up right away.

Degenerative spondylolisthesis

Degenerative spondylolisthesis is the result of wear-and-tear changes in the spine, typically developing over decades. As the discs between the vertebrae lose height and the joints in the back of the spine (facet joints) become arthritic, the spine can become unstable, allowing one vertebra to gradually slip forward. 

This type is much more common in adults over 50 and tends to show up more frequently in women than men. It’s closely linked to the natural aging process and often accompanies other degenerative spinal conditions.

Other less common types of spondylolisthesis

While isthmic and degenerative forms are by far the most common, spondylolisthesis can also result from other, less typical causes. Traumatic spondylolisthesis occurs when a sudden injury (like a severe fall or accident) causes a fracture that destabilizes the spine. 

Dysplastic spondylolisthesis is a congenital condition, meaning a person is born with abnormal bone formation that makes slippage more likely. Lastly, pathological spondylolisthesis can happen when a disease process – such as a tumor or infection – weakens the bones and leads to slippage.

Causes and Risk Factors

The underlying causes of spondylolisthesis vary depending on the type, but they all involve some form of weakness or instability in the spine that allows a vertebra to slip out of place.

Isthmic spondylolisthesis

The main driver of isthmic spondylolisthesis is a stress fracture in the pars interarticularis. This usually develops over time from repetitive strain rather than a single traumatic event. Sports and activities that involve frequent hyperextension (bending backward) of the spine – such as gymnastics, diving, weightlifting, and football – can significantly increase the risk. Genetics may also play a role in predisposing certain individuals to weaker bone structures, but mechanical stress is the key trigger here. Many people with isthmic spondylolisthesis first develop the initial crack (called spondylolysis) during adolescence, especially if they’re highly active.

Degenerative spondylolisthesis

This type is primarily driven by age-related changes. Over the years, the spinal discs lose water content and shrink, while the facet joints wear down and may develop arthritis. This combination leads to instability in the spine. Risk increases with age and women tend to be at higher risk, possibly due to differences in bone density and joint mechanics. A family history of spine problems can also contribute, but the main factor here is the gradual degeneration that comes with aging.

Other less common types

• Traumatic spondylolisthesis results from a sudden injury, like a car accident or a hard fall, that fractures part of the vertebra and destabilizes the spine.

• Dysplastic spondylolisthesis is caused by congenital abnormalities in spinal formation, meaning the person is born with a defect that makes slipping more likely over time.

• Pathological spondylolisthesis occurs when diseases – such as tumors, infections, or certain bone disorders – compromise the structural integrity of the vertebrae.

Spondylolisthesis Symptoms

The symptoms of spondylolisthesis can range from mild to quite uncomfortable, depending on how much the vertebra has slipped and whether nerves are involved. While some people have no symptoms at all – especially in the early stages – others may notice increasing discomfort as the condition progresses.

For both isthmic and degenerative spondylolisthesis, lower back pain is often the main complaint. This pain can be persistent or may flare up with certain movements, especially activities that involve bending backward or standing for long periods. In cases where the slipped vertebra presses on nearby nerves (most commonly in the lumbar spine), radiating leg pain can develop. This may feel like sharp, shooting pain, tingling, numbness, or even weakness that travels down the buttock and into the leg, a pattern often referred to as sciatica.

Other common symptoms include stiffness and reduced flexibility in the lower back, as well as tightness in the hamstring muscles. Some people also experience a feeling of instability or heaviness in the legs, particularly after walking or standing.

In more severe cases – especially when nerve compression is significant – there may be changes in sensation, reflexes, or even motor control in the legs. Rarely, severe nerve involvement can lead to bowel or bladder dysfunction, which requires immediate medical attention.

The pattern of symptoms may differ slightly based on the type of spondylolisthesis. For example, isthmic spondylolisthesis often shows up in younger, more active individuals with pain triggered by sports or physical exertion, while degenerative spondylolisthesis tends to cause chronic, gradually worsening back and leg pain in older adults.

Spondylolisthesis Grades and Classification

Spondylolisthesis isn’t just described by its type – it’s also graded based on how far one vertebra has slipped forward over the one beneath it. This grading helps doctors assess severity and decide on the best treatment approach.

The system most commonly used is the Meyerding classification, which divides slippage into five grades:

• Grade I: 1% to 25% slippage

• Grade II: 26% to 50%

• Grade III: 51% to 75%

• Grade IV: 76% to 100%

• Grade V (spondyloptosis): The vertebra has completely fallen off the one below it

Most cases fall into Grade I or II, and these milder slips often respond well to non-surgical treatments like physical therapy, activity modification, and pain management. Higher grades, especially Grade III and above, may cause more pronounced symptoms and can be harder to manage without surgery, particularly if nerve compression or spinal instability is significant.

In general, the greater the slippage, the more carefully doctors monitor for signs of nerve involvement or worsening instability. However, treatment decisions are also guided by the patient’s symptoms, overall health, and personal goals – not just the grade alone.

How is Spondylolisthesis Diagnosed?

Diagnosing spondylolisthesis typically starts with a physical exam and a detailed look at your symptoms. During the exam, a doctor may check for tenderness in the lower back, assess flexibility and range of motion, and look for any neurological signs – such as weakness, numbness, or changes in reflexes – that could suggest nerve involvement.

To confirm the diagnosis and determine the severity, imaging tests are essential. An X-ray is usually the first step, as it clearly shows whether one vertebra has slipped out of place. If there’s concern about nerve compression or more detailed spinal changes, your doctor may order a CT scan or an MRI to get a better view of bones, discs, and surrounding soft tissues.

Spondylolisthesis Treatments

The main goal of treating spondylolisthesis is to reduce pain, improve function, and stabilize the spine. Treatment plans are tailored based on the type and severity of the condition, the degree of slippage, and how much it’s affecting daily life.

Nonsurgical options

For most people – especially those with mild to moderate slippage – nonsurgical treatment is the first step. This typically includes:

• Physical therapy to strengthen the muscles that support the spine, especially the core and lower back. Improving flexibility and muscle balance can help relieve pressure on the affected area and reduce symptoms. 

• Pain management using medications like NSAIDs (nonsteroidal anti-inflammatory drugs), heat therapy, or, in some cases, targeted injections to calm inflammation around irritated nerves.

• Bracing may be recommended in certain cases, particularly for younger patients or during flare-ups, to limit movement and allow healing.

The focus is on helping patients return to normal activities while preventing further slippage or flare-ups.

Surgical options

Surgery becomes an option when nonsurgical treatments haven’t provided relief, or if there are significant neurological symptoms, severe slippage (often Grade III or higher), or worsening instability. In these cases, the goal is to decompress any pinched nerves and stabilize the spine permanently.

Common surgical procedures include:

• Spinal fusion, where two or more vertebrae are permanently joined together to prevent further movement and slippage.

• Decompression (such as laminectomy), which removes part of the bone or tissue that’s pressing on nerves.

Sometimes, both procedures are done together to relieve nerve pressure and maintain spinal stability.

Recovery from surgery can vary based on the specific procedure and individual health, but most patients spend a few days in the hospital and gradually return to daily activities over several weeks to months. Physical therapy is usually part of recovery to rebuild strength and mobility.

Where Can I Learn More About Spondylolisthesis and Related Conditions?

If you’re dealing with back pain that impacts your daily life, LifeMD may be able to help. While LifeMD doesn’t treat spondylolisthesis directly, we do offer helpful resources on managing back pain and can prescribe medication for symptom relief when clinically appropriate. 

Get started today to learn more. 

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