1. Understanding Spondylolisthesis

2. If you’ve been diagnosed with spondylolisthesis,
taking time to research your condition can help
you better understand what is causing your
discomfort. The spinal condition generally
involves the forward slippage, or displacement,
of one vertebra over the one below it, though
backward slippage is also possible. While
slippage can occur in the cervical (neck) and
thoracic (mid-back) regions of the spine, it is
most commonly diagnosed in the lumbar (lower
back) spine.

3. Measuring the Degree of Slippage
The severity of spondylolisthesis is measured by a grading system, which classifies the
degree of slippage in relation to the rest of the spine. The scale ranges from Grade I to
Grade IV where:
• Grade I is less than 25 percent slippage
• Grade II is 26 to 50 percent slippage
• Grade III is 51 to 75 percent slippage
• Grade IV is 76 to 99 slippage
Grade V is technically not a part of the grading system, but is sometimes used to
denote 100 percent vertebral slippage, where an affected vertebra has slipped
completely off the vertebra beneath it. Establishing your level of slippage is essential
for your doctor to formulate an effective treatment plan. For example, if you are
assigned a Grade I or II, you may find relief from symptoms with a variety of
noninvasive treatments, but if you’re diagnosed with high-grade spondylolisthesis, the
more likely it is that you will need surgery.

4. What’s the Difference Between the
Types of Spondylolisthesis?
Along with knowing your degree of slippage, your doctor will also want to determine
the reason behind your vertebral slippage. There are several different types of
spondylolisthesis, the most common forms being degenerative, congenital, and
isthmic spondylolisthesis.
Degenerative vertebral slippage is the most commonly diagnosed form of the
condition. The spinal components begin to deteriorate over time due to normal wear
and tear. More specifically, as intervertebral discs lose water content, they weaken and
may lose the ability to properly support adjacent vertebrae, which can lead to
displacement.
Congenital spondylolisthesis is present at birth and occurs due to abnormal formation
of the vertebrae, which creates a higher risk for slippage. Isthmic spondylolisthesis can
occur when a buildup of stress fractures in the pars interarticularis (narrow areas of
bone located between upper and lower facet joints) eventually weaken the bone to
the point of breakage and vertebral displacement.

5. Treating Your Symptoms
Discomfort caused by vertebral slippage may include difficulty walking, muscle spasms, and hamstring
stiffness, but may also arise as a result of nerve compression. If you have developed low-grade
spondylolisthesis, it’s possible that you won’t experience any symptoms, unless the displaced bone
comes into contact with the spinal cord or a nearby nerve root, which will depend on the degree and
location of slippage.
Your doctor will likely recommend a conservative, or nonsurgical, approach to symptom mitigation if
you experience shooting pain, numbness, weakness, and tingling that radiate into your arms or legs.
While your specific treatment regimen will vary from that of another patient, in general, your doctor
may recommend one or more of these therapies:
• Non-steroidal anti-inflammatory drugs (NSAIDs)
• Opioid pain medication
• Hot/cold therapy
• Physical therapy
• Back or neck bracing
Surgery will not be considered as a treatment option in the majority of spondylolisthesis cases,
particularly those that are diagnosed as low-grade. In the event your symptoms persist, even after
several weeks or months of conservative therapies, your doctor may then recommend surgery.

6. When Surgery Becomes an Option
If your doctor asks you to consider spondylolisthesis surgery,
make sure you carefully and thoroughly research all of the
options available to you. Unless you have an emergent,
traumatic injury or high-grade vertebral slippage requiring
highly invasive, open spine surgery, you may be a candidate
for an endoscopic procedure. Similar to some open back or
neck surgeries, an endoscopic procedure will focus on
relieving the pressure that your slipped vertebra is placing on
your spinal cord or a nerve root. However, endoscopic
methods are far less invasive, requiring only a small incision
near the affected area, no muscle dissection, and a drastically
reduced recovery period.