Spondylolisthesis - Cause, symptoms and treatment

What really is spondylolisthesis? Spondylolisthesis means that there has been a displacement of a vertebra or cervical vertebra - this can occur forward (anterolistesis) or backward (retrolistesis). Normally this happens at the bottom of the spine. The most common form of spondylolisthesis is the one that hits the lower back - called lumbar spondylolisthesis. Such spondylolisthesis occurs in varying degrees and can include defects of so-called pairs in severe cases.

Cause of spondylolisthesis

There are several possible causes of spondylolisthesis.

Genetic / congenital: One of the most common causes of this diagnosis is that you are born with it.

Infection: For bone infections, cancer, rheumatic disorders (eg. rheumatic arthritis) and various joint diseases, the vortices can be broken down and permanently damaged. This can lead to displacement in relation to its natural position due to lack of carrying capacity and strength.

Trauma / fall: Falls from heights, car accidents or similar trauma with a high load on the spine - especially the lower part - can cause the vertebrae to move and come out of their natural position.

Turn and acrobatics: Children and adolescents who are active in gymnastics and acrobatics are more prone to spondylolisthesis than others. It is speculated whether this is due to the high focus on stretching and repetitive strain on a spine that has not yet fully grown.

Spondylysis of L5 over S1 seen by X-ray.

Spondylysis of L5 over S1 as seen in X-ray.

Symptoms of spondylolisthesis

It is important to mention that many - perhaps most - with spondylolisthesis are asymptomatic. This means that they neither know that they have this misalignment in their backs nor that they are significantly bothered by it. The symptoms of this diagnosis are also quite generalized and overlap with a number of other back diagnoses.

Some of the most common symptoms can be:

Low back pain: In lumbar spondylolisthesis this can result in a number of compensations in the muscles and joints. These can be annoyed at all the extra tasks and are happy to tell about this by sending pain signals.

Muscle tightness and muscle tension: In lumbar spondylolisthesis, the back muscles must compensate for a joint being in the wrong position - this leads to a different biomechanics where the muscles have to do a bigger job than they might do in someone without spondylolisthesis.

Referred pain down one or both legs: Misalignment of the vertebrae (especially with spondylolisthesis at the very bottom of the lower back) can cause irritation, indirect or direct pressure on nearby nerves. This irritation can be the basis for sciatica symptoms / ailments - which is synonymous with neurological symptoms and pain down one or both legs.

Pain in the seat: In the same way as overcompensation in the back muscles, the buttock muscles must also work overtime to stabilize the part of the back that is out of its natural position. This can cause a feeling of tightness and stiffness in the pelvis - as well as in some cases, false sciatica.

Treatment of spondylolisthesis

Physical treatment: Treatment of dysfunction in muscles and joints can provide symptom relief and functional improvement - but must be combined with exercise if one has hopes of long-term improvement.

Surgery / surgery: This is normally only valid for those who have spondylolisthesis due to a car accident or other severe trauma. The operation involves, like other back surgery, a high risk and must therefore only be used when it is extremely necessary. It is also only used as a last resort. The most common operation against spondylolisthesis involves attaching the affected vertebra to the next vertebra - with steel screws - to avoid further deterioration. We advise against this, as I said, if it is not absolutely necessary - due to a high chance of deterioration or late injuries.

Training: The most important thing in relation to spondylolisthesis is functional and strong core and back muscles. A strong core and back will stabilize the spine and reduce loads that would otherwise have ended up against joints, ligaments and nerves. If you are unsure of what kind of training this entails or if you need an exercise program - then you are advised to contact physical therapist or modern chiropractor for setting up a training program customized for you.

Special training with exercise bands can be particularly effective for building pelvis and seat muscles. Muscles that are essential to relieve sacrum and lumbosacral transition (where the lower lumbar vertebra meets sacrum). Below you will find an exercise that is used against pelvic relaxation and among athletes (called the ØSTERS exercise):