Understanding Spondylolisthesis
Spondylolisthesis is a condition in which one vertebra slides forward relative to the vertebra below it. This slippage can narrow the spinal canal, compress nerve roots, and cause instability that leads to both back pain and radiating leg symptoms. It is most common in the lumbar spine at the L4–L5 and L5–S1 levels.
Spondylolisthesis is graded by the degree of slippage — from Grade I (less than 25% slippage) through Grade IV (greater than 75%). Most patients have low-grade slippage that responds well to conservative care. Higher grades, progressive slippage, or significant neurological involvement are more likely to require surgical intervention.
- Low back pain, often worse with activity
- Pain, numbness, or weakness radiating into the leg
- Tight hamstrings or difficulty walking
- Stiffness in the lower back
- Pain relieved by sitting or bending forward
- Muscle spasm in the low back
- In severe cases, difficulty with bladder or bowel control
- Degenerative disc and facet joint disease (most common in adults)
- Stress fracture of the pars interarticularis (isthmic — common in younger patients)
- Traumatic fracture
- Congenital (present from birth)
- Post-surgical — adjacent segment disease following prior fusion
Treatment Pathway
Most spine conditions are managed with a stepped approach — starting with the least invasive option and progressing only when needed. Our surgeons evaluate each patient individually.
When Surgery May Help
Surgery for spondylolisthesis is most commonly indicated when significant leg pain or neurological deficit fails to improve with conservative care, when the slip is high-grade, or when there is evidence of instability or progression. Posterior lumbar interbody fusion (PLIF or TLIF) addresses both decompression and stabilization in a single procedure. Minimally invasive TLIF is an option for appropriate candidates, offering reduced blood loss and faster recovery compared to open surgery.