Spondylo-
listhesis
When one vertebra slides forward over the one below it — affecting spinal stability and potentially compressing nerve roots.
Spondylolisthesis
A forward slip of one vertebra over another — affecting stability and sometimes compressing nerve roots.
Most low-grade cases are managed without surgery. Physiotherapy targeting core stability is the foundation. Surgery is considered when the slip is progressive or significantly affecting nerve function.
Overview
Spondylolisthesis occurs when one vertebra slides forward relative to the one below it. Most clinically significant cases fall in the Grade I or II range. The lumbar spine — particularly L4–L5 and L5–S1 — is most commonly affected. It can occur at any age: degenerative forms are common in adults over 50, while isthmic forms are more often seen in younger patients and athletes.
What Causes It?
Degenerative spondylolisthesis results from age-related breakdown of the disc and facet joints that normally prevent forward slip. Isthmic spondylolisthesis results from a stress fracture in the pars interarticularis — particularly associated with repeated spinal extension activities common in cricket, gymnastics, and weightlifting.
What Does It Feel Like?
Low back pain is the most consistent symptom — often a deep, central ache that worsens with prolonged standing, walking, or activity that loads the lumbar spine. Where slippage compresses nerve roots, radiating leg pain, numbness, or weakness similar to sciatica may also be present.
How Is It Diagnosed?
Standing X-rays are the most important initial investigation — they show the degree of slip under load, which MRI taken lying down may underestimate. MRI provides detail on nerve compression and disc status. Flexion-extension X-rays assess instability — whether the slip changes with movement.
Non-Surgical Treatment
Physiotherapy targeting lumbar stabilisation — strengthening the deep abdominal and paraspinal muscles — is the foundation of conservative management. Activity modification and anti-inflammatory medications can provide symptomatic relief during acute episodes. Most Grade I and II cases are successfully managed without surgery.
When Is Surgery Considered?
Surgery is considered when conservative care hasn't produced adequate relief, when the slip is progressive on serial X-rays, when neurological symptoms are present and not improving, or when functional limitations are significant and persistent.
Recovery
Patients are typically mobile within 24–48 hours and discharged within three to five days. Return to desk work is generally possible within six to eight weeks. Return to physical activity and sport takes three to six months or more, guided by clinical progress and imaging confirmation of fusion.
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