Spondylolisthesis: symptoms, treatment, causes and when surgery is needed

The NHS says spondylolisthesis does not always cause symptoms. When it does, the main ones are listed below. A published review of the condition (an open-access journal article, not UK-specific) adds that low-grade slips often cause no significant symptoms, whereas higher-grade slips are more likely to cause back pain and leg symptoms.

• Pain in your lower back, often worse when standing or walking and relieved when sitting or bending forward.

• Pain spreading to your bottom or thighs.

• Tight hamstrings (the muscles in the back of your thighs).

• Pain, numbness or tingling spreading from your lower back down 1 leg (sciatica).

The NHS says treatments depend on the symptoms you have and how severe they are. Common treatments are listed in the table. A GP may refer you to a physiotherapist, or you can refer yourself in some areas. Waiting times for physiotherapy on the NHS can be long, and you can also pay to have it privately. The Chartered Society of Physiotherapy has a directory to find a physiotherapist.

The review states that non-surgical management is the first-line approach for low-grade slips and that most people experience symptom relief with conservative treatment. It says epidural steroid injections can give short-term pain reduction though the long-term effect is variable, that bracing is sometimes used in young athletes with low-grade slips, and that if there is no improvement after at least four to six weeks of physiotherapy, alternatives should be considered. It also cautions that anti-inflammatory painkillers should be prescribed with caution in older people with other health conditions.

The spine is a stack of bones called vertebrae. In spondylolisthesis, the NHS says, one of them slips forward. It can be painful but there are treatments that help.

The published review describes the most common types as isthmic and degenerative. Isthmic spondylolisthesis is particularly common in young adults in sports involving repeated hyperextension of the lower back, such as gymnastics or weightlifting. Degenerative spondylolisthesis is linked to wear in the joints and discs of the spine. The review estimates that isthmic spondylolisthesis affects about 4% to 8% of the general population.

Doctors commonly grade a slip on X-ray using the Meyerding system, according to the review. The grade helps guide treatment, but severity of slip does not always match how bad symptoms are.

The NHS lists three routes: it can happen as you get older, because the bones of the spine can weaken with age; it can run in families; and it can be caused by a tiny crack in a bone (a stress fracture), which is more common in young athletes and gymnasts.

The NHS says the GP may examine your back and ask you to lie down and raise 1 leg straight up in the air. This is painful if you have tight hamstrings or sciatica caused by spondylolisthesis. The GP may arrange an X-ray to see if a bone in your spine has slipped forward, and you may have other scans, such as an MRI scan, if you have pain, numbness or weakness in your legs.

The NHS says a GP may refer you to a specialist for back surgery if other treatments do not work. There are two main types: spinal fusion, where the slipped vertebra is joined to the bone below with metal rods, screws and a bone graft, and lumbar decompression, a procedure to relieve pressure on the compressed spinal nerves. The operation is done under general anaesthetic. Recovery from surgery can take several weeks, but it often improves many of the symptoms. Talk to your surgeon about the risks and benefits.

The published review says surgery is typically reserved for people with progressive neurological deficits, severe pain or significant instability, and that the choice between decompression alone and decompression with fusion remains debated.

The NHS advises seeing a GP if any of the following apply.

• You have lower back pain that does not go away after 3 to 4 weeks.

• You have pain in your thighs or bottom that does not go away after 3 to 4 weeks.

• You are finding it difficult to walk or stand up straight.

• You have pain, numbness and tingling down 1 leg for more than 3 or 4 weeks.

• You have other symptoms as well as pain, such as a high temperature, sweating at night, or you have lost weight without trying to.

• You are worried about the pain or struggling to cope.

The NHS back pain page says to call 999 or go to A&E if you have back pain and any of the following. Do not drive yourself to A&E.

• Pain, tingling, weakness or numbness in both legs.

• A loss of feeling around your genitals or anus.

• Changes in your bladder or bowels, such as difficulty peeing, or peeing or pooing yourself.

• Changes in how your penis or vagina feels during sex, not being able to get or keep an erection, or not being able to orgasm.

• The pain started after a serious accident, such as a car accident.

The usual NHS route is GP assessment, X-ray, physiotherapy and then specialist spinal referral if other treatments fail or nerves are affected. In many areas community MSK services take self-referrals for physiotherapy. Some people choose private physiotherapy or a private spinal consultation for faster review. Whichever route, it is worth asking the surgeon about the expected benefit of fusion versus decompression for your type of slip, the risks, the recovery period and the alternatives.