Back (Lumbar)

Spondylolisthesis

Name: Spondylolisthesis
Creator: Dr. Kwang Lee

척추 전방전위증

Forward slippage of one vertebra on the one below

Written and edited by Dr. Kwang Lee, D.C., L.Ac. · Updated 2026-10-04

How common: Relatively Common
Typical age: Adolescents & 40–60s

What is it?

One vertebra slips anteriorly on the vertebra below. Isthmic type (pars defect) occurs in young athletes; degenerative type occurs in middle-aged women (L4-L5).

Commonly affected: L4-L5 (degenerative), L5-S1 (isthmic) most common

How it develops

Pars Defect or Facet DegenerationStress fracture of pars interarticularis (isthmic) or facet arthropathy (degenerative)
Anterior Vertebral SlipUpper vertebra slides forward; graded I–IV by Meyerding classification
Hyperlordosis & InstabilityCompensatory hyperlordosis; instability causes pain with extension
Secondary Foraminal StenosisSevere slippage can narrow the foramen, causing radiculopathy

Symptoms

Chronic Low Back PainAching low back pain worse with lumbar extension and prolonged standing
Buttock/Thigh Referred PainReferred pain to buttocks and posterior thighs (pseudo-sciatica)
Waddling GaitWaddling gait due to pelvis instability and tight hamstrings
Hamstring TightnessTight hamstrings (protective posture to stabilize pelvis)
Step-Off DeformityPalpable step at L4-L5 level on examination

How it is examined

Step-Off SignPalpable step-off at spinous processes of slipped segment
Limited ExtensionLumbar extension limited and reproduces back/leg pain
Variable SLRPositive SLR only if foraminal stenosis causes radiculopathy

Imaging

Lateral X-ray is diagnostic — shows forward slip. Meyerding grading: I (<25%), II (25–50%), III (50–75%), IV (>75%).

Anterior slip of L4 on L5
Pars defect (spondylolysis)
Increased lumbar lordosis

MRI evaluates degree of canal/foraminal stenosis and neural compression from the slip.

Foraminal stenosis
Thecal sac displacement
Degenerative disc changes

Non-surgical care

Core StabilizationDeep core exercises (transversus abdominis, multifidus) improve spinal stability
NSAIDs + Physical TherapyAnti-inflammatories for pain; PT focuses on stabilization exercises
Activity Restriction (Young Athletes)Restrict high-impact sports; brace may help in adolescents with acute pars fracture

Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.

When surgery is considered

Grade II+ slip with disabling pain, neurological deficit, or failed 6 months conservative care

Procedures that may be discussed

Decompression + posterior interbody fusion (PLIF/TLIF)
Percutaneous pedicle screw fixation

Outlook

Grade I–II managed conservatively in most cases. Surgery has 85–90% success rate.