Spondylolisthesis

What is spondylolisthesis?

Normally, each vertebrae is stacked on top of each other with the help of vertebral discs, which are soft discs that act as a cushion between each vertebrae. All of these vertebrae form the vertebral column, which is in charge of keeping our back straight, our head up and also absorbs the shock of activities like running or jumping. 

In spondylolisthesis, these vertebrae lose their connection to the vertebrae directly above them and end up slipping, which can press on the nerves running through the vertebral column and also strain the back muscles and ligaments.

Although it usually happens in the lower back, it may also happen at the level of the neck and upper back.

What are the symptoms of spondylolisthesis?

The main symptoms of spondylolisthesis are:

• Pain in the lower back, which can be worse when standing or walking, and can feel better once you sit down or bend forward

• The pain can run down to your bottom or thighs

• Your thighs may also feel tight and stiff, especially at the back

• Pins and needles, pain or numbness that can spread from your back down to one leg, also known as sciatica

In some people, spondylolisthesis may not cause any symptoms at all.

How common is spondylolisthesis?

It’s thought that in the UK, 1 in every 20 people will develop spondylolisthesis due to a weak vertebral column, although most cases will be asymptomatic. 

What causes spondylolisthesis?

We know that the main cause of spondylolisthesis is the loss of connection or break between vertebrae, which make them easy to slip forward. This process is called spondylolysis, and can have several different causes:

• Degenerative – Over time, the disc that cushions the vertebrae erodes and can’t stop the vertebrae from sliding out of place. This is the most common reason in older adults. 

• Isthmic – Small cracks in the vertebrae form, usually due to sports like wrestling, football or gymnastics.

• Congenital – Some people are born with a vertebral column that is misaligned and prone to slipping more easily.

What are the different grades of spondylolisthesis?

Depending on the severity, you can have:

• Low grade spondylolisthesis – This is where up to half of the vertebra may slip out of place. This doesn’t usually require surgery.

• High grade spondylolisthesis – This is a more severe spondylolisthesis, where more than half of the vertebra become displaced. It may require surgery. 

How is spondylolisthesis diagnosed?

When you see a GP, they will ask you about your symptoms and your overall health. They may then examine your back and ask you to perform a few movements. This could include lying you down on the bed and raising your leg straight up in the air to see if this is painful for you. They may then arrange an X-ray to check if any of your vertebrae have slipped out of place or an MRI scan if they want a fuller picture.

How is spondylolisthesis treated?

If you want to avoid spondylolisthesis or stop it from coming back, we recommend:

• Doing regular exercise to strengthen the back and tummy muscles

• Maintain a healthy weight, as being overweight can put extra stress on your vertebrae

• Eat a well-balanced diet to keep your bones healthy and strong

Your doctor will base your treatment according to your symptoms and preferences. Some general advice for managing spondylolisthesis includes:

• Avoid bending, lifting, athletics and gymnastics, as these activities can make spondylolisthesis worse.

• Strengthen your back with regular exercises like walking, plank pose, side planks and pelvic tilts.

• Stretch your legs and glutes to help alleviate pain and tension.

• Sit in chairs with a backrest to support the lower back. Sit with a straight back, with your shoulders back and relaxed, legs uncrossed and level hips. Avoid any awkward positions, such as bending, twisting or slouching.

• Take pain medicine like ibuprofen to help relieve pain. If these aren’t enough, a doctor may recommend steroid injections.

A doctor may refer you to physiotherapy may help you by stretching the muscles in your back and tummy. As a last resort, surgery can also be performed to stick the vertebrae together to stop them from slipping, or free the nerves in your back from any pressure that’s causing you pain.

As there are several routes of treatment, you should talk to a GP about the benefits and risks of each option.

When should I speak to a doctor?

Speak to a GP if you’ve had back pain, particularly if it’s causing severe pain, numbness or weakness. It’s important that you go to A&E if you develop any incontinence or numbness when you wipe your bottom. 

You should get help urgently if you:

• Have back or leg pain that has lasted for more than 3-4 weeks

• Are struggling to walk or stand up straight

• Have pain, numbness or tingling down your leg for more than 3-4 weeks

• Pain is worse at night

• Pain does not get better with rest

• You have had some unexplained weight loss

• Have a fever

How can Livi help?

A Livi doctor can ask you questions about your symptoms and recommend a treatment or refer you to a specialist if needed.