Spondylolisthesis

The information presented clearly demonstrates that the diagnosis is the same, but its course varies from person to person! Therefore, there are no universal treatment plans or general recommendations.

Olga Zhirnokletova

Radiologist, highest qualification category, 12 years of experience.

June 10, 2026

The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, diagnostic tests should be prescribed only by the attending physician. For a diagnosis and appropriate treatment, please consult your attending physician.

Table of contents:

General information

Causes of spondylolisthesis

Risk factors

Stages of development

Classification and types of spondylolisthesis

Symptoms of spondylolisthesis

Complications

Diagnosis of spondylolisthesis

Treatment of spondylolisthesis

Interstitial electrical stimulation

Prognosis and prevention

Literature

This is a pathological condition in which vertebrae slip. The vertebra above shifts its position relative to the one below. Due to the altered spinal anatomy, the patient experiences a range of unpleasant symptoms. Neurological disorders and severe complications can develop, including disability and loss of quality of life.

Traumatologists, neurologists, and vertebrologists specialize in diagnosis, treatment, and prevention. If surgery is required, a consultation with a neurosurgeon is essential. The sooner specialist attention is sought, the better the prognosis.

General information

The disease has no age limit: it is diagnosed in both adults and children. The displacement occurs in the cervical, thoracic, or lumbar spine, and can be overt or latent. It is most often diagnosed in people aged 20-40. Overall, the disease affects 3-6% of the population. It is found in men in 65% of cases.

Causes of spondylolisthesis

Pathological changes do not occur spontaneously. They are usually caused by other abnormalities or precipitating factors.

Main reasons:

• tumor process in the projection of the spinal column;
• congenital anomalies of the skeletal structure;
• osteochondrosis;
• joint degeneration;
• trauma;
• sports injuries (even if there was a small hematoma, bruise, or ligament tear, this is enough for the development of spondylolisthesis);
• anatomically incorrect position of the sacrum: if the upper part of the sacrum is not able to properly distribute the load, then excess pressure occurs on certain segments of the column, which can cause slipping.

Provoking factors also include a passive lifestyle, bone defects, arthrogryposis, radiculitis, and arthrotic changes in the joints.

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Risk factors

Those at risk include those with musculoskeletal disorders and a history of rheumatological diseases (lupus, gout, arthritis, etc.). It is also quite common in those with long-term systemic conditions and chronic infectious diseases.

Risk factors include traumatic and extreme sports: gymnastics, hockey, alpine skiing, boxing, hurdle running, and parachute jumping.

Stages of development

The disease is progressive and self-healing is impossible.

Main stages:

• First (initial): There are no obvious symptoms. However, the patient reports pain in the back, especially when in an awkward position or under strain.
• Second (progressive): aching pain occurs both during activity and at rest. In the affected segment, it intensifies with exertion.
• Third: constant pain, most often in the lumbar region. The patient has difficulty performing certain movements of the torso or limbs, and stenosis develops.
• Final (complicated): compression of nerve structures, severe postural changes, a protruding abdomen, and a change in gait (a waddling gait with bent knees) are observed. The patient becomes irritable and suffers from intense pain. Dysfunction of internal organs is observed: some experience decreased potency, urinary incontinence, paresis, and paralysis.

The condition is often diagnosed in the second or third stage. It’s often discovered during a routine appointment with a neurologist or traumatologist. For many, the diagnosis comes as a surprise.

Classification and types of spondylolisthesis

Spondylolisthesis progresses differently in each patient. It is classified based on a number of clinical characteristics.

According to the type of displacement it can be:

• stable: fixed deformation, constant displacement of bone structures;
• unstable: the vertebra can change its position depending on physical activity.

By etiology:

• A pathological type that develops as a result of an inflammatory process or neoplasm. It is characterized by damage to the articular process.
• Dysplastic spondylolisthesis. This disorder is a developmental disorder of the spine. It progresses during childhood, and symptoms appear with aging.
• Isthmic spondylolisthesis. Develops when a vertebra slips. It progresses after physical injury. It is most often diagnosed in professional athletes who practice spinal stretching.
• Degenerative spondylolisthesis. This condition implies the absence of serious disorders. The vertebrae shift due to age-related degeneration of the joint tissues.
• Post-surgical spondylolisthesis. Develops after spinal surgery.
• Traumatic spondylolisthesis. This condition develops due to damage to the ligaments and bones of the spinal column.

In the direction:

• back;
• side;

By the severity of the displacement:

• Grade I – slippage by 1-25%;
• Stage II – deviation of 25-50%;
• Stage III – slippage by 51-75%;
• Stage IV – displacement by 76-100%;
• Grade V – spondyloptosis, complete separation from the lower vertebra.

According to the nature of the flow, the following forms are distinguished:

• acute: the development of spondylolisthesis is caused by traumatic injury to the vertebra (if there was a fracture, dislocation);
• asymptomatic: the patient is unaware that a spinal pathology is developing, since there are no clinical signs;
• protracted: dysplasia is combined with degenerative changes in the vertebral arches, pain syndrome appears periodically and may subside;
• uncomplicated: no progression of spondylolisthesis, the disease develops slowly, without complications or associated dysfunctions, the symptoms are not extensive.

Doctors always look for ways to help the patient by assessing the overall clinical picture!

Symptoms of spondylolisthesis

Complaints at the initial stage may be atypical and vague. Therefore, a diagnosis is not made based solely on initial symptoms. Further examination is performed.

Depending on the location of the pathology, the following symptoms appear:

• moderate, mild or severe pain (sharp or aching in nature);
• physical weakness: decreased range of motion in the limbs, inability or difficulty in performing certain physical exercises;
• combination of pain syndrome: in the lumbar region, sternum and neck (especially if degenerative-dystrophic changes are present);
• progression of osteochondrosis;
• change of the pelvis (possible tilt forward or backward);
• shortening of the trunk (in severe and aggressive cases of the disease);
• muscle contracture;
• gluteal muscle hypotrophy
• decreased sensitivity in the projection of innervation;
• development of radicular syndrome;
• increased sweating of the skin (not only in the area of ​​pathology);
• nervousness, tendency to depressive states;
• drowsiness, weakness, fatigue;
• impairment/decrease of hearing function;
• impairment/decrease of visual function;
• insomnia;
• episodes of dizziness, fainting;
• tinnitus;
• attacks of suffocation;
• dry cough;

The pain is felt or intensifies upon palpation of the spine, or during prolonged standing, sitting, or bending.

Complications

Spondylolisthesis contributes to the development of neurological disorders. These arise from compression of the nerve roots and narrowing of the canal.

Long-term consequences and complications include:

• the appearance of a feeling of heaviness in the lower limbs;
• urinary incontinence;
• paresis;
• a tingling sensation throughout the body (locally: in the lumbar region, thighs);
• discomfort in the perineum;
• muscle wasting;
• decreased sensitivity;
• difficulty raising the leg while lying on the back, accompanied by a feeling of tension.

A comprehensive examination is crucial. A person can spend years treating incontinence, taking painkillers, and battling a nonexistent rheumatological condition. And all of this will be in vain, as the underlying cause is spondylolisthesis. Only a comprehensive approach can identify all dysfunctions and take steps to restore health, normalize well-being, and return to a normal lifestyle.

Diagnosis of spondylolisthesis

During the consultation, the doctor first listens carefully to the patient’s complaints. A conversation and examination follow: a neurologist or traumatologist visually assesses the skeletal structure, checking for any deformities, significant signs of displacement, or associated rheumatological, neurological, or traumatic changes.

Typically, the affected area responds with discomfort when pressure is applied. If the condition is advanced, a depression or small protrusion may be felt.

Depending on the examination results, the following is prescribed:

• X-ray;
• CT;
• MRI;
• laboratory tests.

The images help determine the angle of displacement, the stage of the disease, and the extent of the slippage. Laboratory tests are used to assess the overall condition of the body and determine whether an infectious agent is present.

Treatment of spondylolisthesis

In the early stages, a watchful waiting approach is sometimes chosen. If the underlying cause of the problem can be addressed and the syndrome can be controlled with medication, lifestyle modifications are recommended, and measures are taken to eliminate triggers. Painkillers and anti-inflammatory medications are sometimes prescribed.

Physical therapy is very helpful. Specific exercises help strengthen the muscular frame and joints. It’s not exhausting: physical therapy is easy, and by accelerating lymph flow, normalizing breathing, and saturating cells with oxygen, an overall improvement in mood and well-being is noted.

Drug treatment

The main goal of therapy is to relieve pain and inflammation, and reduce or completely eliminate soft tissue swelling. Medications are selected depending on the patient’s age.

Don’t trust dubious advertising or resort to dietary supplements. Not only are they ineffective, they can worsen the disease.

Medication treatment must be carried out strictly under the supervision of a physician – experiments are unacceptable!

Physiotherapy

Physiotherapy procedures relieve spasms, normalize blood flow, and have a positive effect both locally and overall.

The most effective are:

• diadynamic therapy (currents of constant polarity are directed, providing myostimulating, analgesic, and trophic effects);
• electrophoresis;
• sinusoidal currents, etc.

The first stage involves a course of physiotherapy to achieve therapeutic results more quickly. Subsequent treatments are administered as indicated, either for prevention or to mitigate residual effects.

Surgical intervention

Surgery is used in cases where the vertebrae are displaced regardless of the patient’s posture. Sometimes, surgical techniques are used even for grade 1 displacement, for example, in unstable spondylolisthesis.

Reasons for intervention:

• age up to 14 years;
• increase and intensification of unpleasant sensations;
• stiffness of movement;
• disease progression.

Surgery is typically scheduled 3-6 months after diagnosis and initiation of drug therapy. If there is no response, the patient is offered surgical correction after six months.

Methods used:

• fastening and fixation of vertebrae with screws;
• foraminotomy (expansion of the root canals to achieve a decompression effect);
• Laminectomy: removal of scar tissue, resection of arches, stabilization of vertebral segments;
• installation of implants.

Preparation for surgery takes only a few days. Complete blood count and urine tests, an ECG, CT scan, and vascular ultrasound are required. Additional tests are prescribed for more severe cases of spondylolisthesis.

Manual therapy

It is considered one of the most effective methods for this condition. A chiropractor uses specialized pressure and adjustment techniques to restore the anatomically correct position of the spinal segments. During the session, work is also carried out to normalize blood circulation and the musculoskeletal system.

After just the first session, many report increased range of motion, dramatic improvement, and the disappearance of painful symptoms. However, it’s important to remember that this method is only effective when performed by a qualified, medically qualified professional. A refresher course alone is insufficient to master the techniques and provide competent care to patients with severe traumatic disorders. Careful selection of a specialist is essential!

Shock wave therapy (SWT)

Shockwave therapy (SWT) is often included in the treatment program. It involves generating high pressure through short-duration sound pulses. This has a beneficial effect on nerve receptors, dilating capillaries, accelerating blood flow, forming a new vascular network, and making fibroid areas softer and more pliable. Osteophytes are destroyed and safely eliminated through the lymphatic system.

Interstitial electrical stimulation

The technique became widespread in the 80s and remains in demand due to its high efficiency.

During the procedure, special plates are applied to the affected area. A current is directed through them. This has a positive effect on the peripheral nervous system. Nutrition is improved, the processes of destruction and degeneration are slowed, muscle spasms subside, and inflammatory lesions are reduced in size. With repeated treatments, muscle tone is restored, which is also important for spondylolisthesis.

Intravenous laser blood irradiation

For some, the name of the method sounds threatening or even frightening. But don’t be distrustful of doctors and medical technology. VLOC is safe.

This method is based on the therapeutic properties of lasers. The radiation produces a biological effect, altering the red blood cells’ ability to change shape (without altering their volume or surface area). This “adaptability” promotes more efficient gas exchange and increases the cells’ energy capacity. They are saturated with oxygen, even at a deep level.

Prognosis and prevention

The prognosis is favorable in many clinical cases. If the patient fully complies with the doctor’s instructions, subsequent restrictions on exercise and extreme sports are minimal.

There is no specific prophylaxis. Basic recommendations:

• undergoing medical examination according to age;
• Athletes who train intensively and experience excessive stress should have an X-ray of the lumbar region as soon as pain occurs (without waiting for consequences and complications);
• X-ray diagnostics are recommended for individuals whose professional activities involve lifting heavy objects, working with loads, or excessive physical exertion;
• During pregnancy, many doctors advise expectant mothers to wear a support belt, do preventative exercises, and avoid wearing high-heeled shoes;
• undergoing a course of vitamin therapy;
• Posture control: if there is a tendency towards deformities, then, in consultation with your doctor, you should periodically wear special frames;
• Strengthening the muscles of the back, shoulders, and legs: it is enough to do simple gymnastics in the morning and ensure moderate physical activity without stress on the body (walking, brisk walking, exercises on the parallel bars, horizontal bar, etc.).

Preventive measures must be comprehensive. A conscious approach to maintaining health is required on the part of the patient.

At the Ramsey Diagnostics clinic, we’ve successfully implemented both conservative and modern technologies. We primarily prescribe NSAIDs, Harm therapy, and vitamin therapy. A comprehensive examination is performed during a single visit, and doctors quickly diagnose and begin treatment. Our patients recover faster, even if the pain seemed permanent!

Literature

• Classification of spondylolisthesis by N. I. Khvisyuk / Kutsenko V. A., Prodan A. I. // Spinal surgery – 2008 – No. 4.
• Mironov S. P., Vetrile S. T., Vetrile M. S., et al. Surgical treatment of spondylolisthesis of the L5 spine using transpedicular fixators // Spinal surgery. 2004. No. 4. pp. 39-46.
• Makarevich CB Spondylodesis with a universal fixator of the thoracic and lumbar spine. – Minsk. – 2001.
• Tager I. L., Mazo I. S. X-ray diagnostics of spondylolisthesis. – M. – “Medicine”. – 1968. – 122 p.
• Arnold P., Winter M., Scheller G., Konermann W., Rumetsch D., Jani L. Clinical and radiological isthmus reconstruction in lumbar spondylolysis and minimal spondylolisthesis. // Z Orthop Ihre Grenzgeb 1996 – May-Jun – 134 (3).
• Dotsenko V. V., Zagorodniy N. V., Sampiev M. T., Vasiliev V. F. Report: “Anterior minimally invasive surgeries for spondylolisthesis”. — III Congress of Neurosurgeons of Russia, — June 4-8, 2002, St. Petersburg.