Injury blog: Spondylolisthesis

TL;DR

Spondylolisthesis is when one vertebra slips forward on another, most often at the base of the spine (L5 on S1). It can be associated with degeneration, stress fractures, trauma, developmental changes, or underlying conditions such as infection or cancer.

Grades range from mild (0–25% slip) to severe (75%+), with Grade 1 being the most common.

Symptoms may include:

• Low back and buttock pain
• Pain down the back of the thigh
• Tight hamstrings
• Altered walking patterns
• Numbness, tingling, or (in severe cases) bowel/bladder issues

Diagnosis involves a detailed history, movement assessment, and, where appropriate, imaging (such as X-rays).

Management is usually non-surgical and may include:

• Education on spine mechanics and posture
• Lifestyle advice (including weight management where appropriate)
• Core stability and flexibility exercises
• Manual therapy to assist with managing muscle tension and joint mobility

👉 The goal is to support pain management, improve stability and function, and help you work towards your individual activity goals.

 

Hello readers! Our blog this month focuses on a spinal condition that in the sports world most commonly affects cricketers and gymnasts, but in reality, can affect anyone! The condition is known as spondylolisthesis (pronounced ‘spon-di-lo-lice-thee-sis’) and most commonly affects the lowest segments of the lower spine region.

What is a spondylolisthesis? 

Spondylolisthesis is the slipping forward of one vertebra on another. This most commonly occurs at the L5 segment (the lowest vertebra in the lumbar spine), which slips forward on the S1 segment of the sacrum. The runner-up is L4, which is also a commonly affected level.

There are a few different causes of this condition, and so it has been classified into different types. There are five categories of spondylolisthesis:

• Degenerative: Occurs due to degenerative changes affecting the spinal facet joints and discs.
• Isthmic: Occurs due to a bone defect in a part of the vertebra known as the pars interarticularis.
• Traumatic: Occurs following trauma that results in a fracture of either the spinal facet joints or the pars interarticularis.
• Dysplastic: Occurs due to a developmental variation of the vertebrae which alters the direction of the spinal facet joints, making slippage more likely.
• Pathologic: Occurs secondary to a medical condition such as infection or cancer.

In theory, any process that weakens the supportive structures of the spinal segments (bones, ligaments, discs, and muscles) may contribute to abnormal movement of the spine.

Grades of spondylolisthesis

Spondylolisthesis is further classified based on the amount of slippage that has occurred:

• Grade 1: Between 0–25% of the vertebral body has slipped forward.
• Grade 2: Between 25–50% has slipped forward.
• Grade 3: Between 50–75% has slipped forward.
• Grade 4: Over 75% has slipped forward.

Grade 1 is the most commonly reported classification, accounting for approximately 75% of cases.

Signs and symptoms

These vary depending on the cause, but may include:

• Low back pain, including pain in the buttocks
• Pain along the back of the thigh, which rarely extends below the knee
• Tight hamstring muscles
• Changes in walking pattern
• Pins and needles and/or numbness down the legs
• Bowel and bladder dysfunction (in more severe cases)

If you come to us with low back and/or leg pain, we’ll take a detailed history and perform a thorough assessment to better understand the factors that may be contributing to your symptoms. This includes asking questions about your medical history and assessing how you move to help guide an appropriate diagnosis and management plan.

Sometimes imaging may be appropriate to help investigate whether spondylolisthesis is contributing to your symptoms, depending on your presentation. Where clinically indicated, we may recommend an X-ray.

Treatment

Most cases of spondylolisthesis can be managed conservatively, meaning non-surgical options are considered before surgery where appropriate. Because instability around the affected spinal segment may contribute to symptoms, one aim of management is to support stability around the area and improve how loads are managed through the spine.

We spend time educating patients about the mechanics of the spine. Understanding what may be contributing to your symptoms can help you make informed decisions about movement and activity. We may also provide advice on appropriate footwear, standing, seated and sleeping postures. Being overweight is one of many factors that may contribute to ongoing symptoms, and where appropriate we can discuss strategies to support your overall health goals.

Exercises to improve core stability and flexibility are often included as part of a management plan. Manual therapy techniques may also be used to assist with managing muscle tension, joint mobility and movement.

The overall aim of management is to support pain management, improve function, and help you work towards your individual goals—whether that’s returning to work, sport, gardening or other everyday activities.

If you’re experiencing low back pain or have been diagnosed with spondylolisthesis, call us on 03 9846 2800 to arrange an assessment and discuss the management options that may be appropriate for you.

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