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Spondylolisthesis is a condition in which a bone (vertebra) in spine slips forward out of the proper position onto the bone below it.

In children, spondylolisthesis usually occurs between the fifth bone in the lower back (lumbar vertebra) and the first bone in the sacrum (pelvis) area.

What causes spondylolisthesis?

In adults, the most common cause is degenerative disease (such as arthritis). The slip usually occurs between the 4th and 5th lumbar vertebrae. Other causes of spondylolisthesis include bone diseases and sudden injury.

In children or younger adults, spondylolisthesis is often due to a birth defect in that area of the spine or sudden injury (acute trauma).

Spondylolisthesis may be found when an x-ray is done for another reason or when back pain occurs.

Certain sport activities, such as gymnastics, weightlifting, and football, put a great deal of stress on the bones in the lower back. They also require that the athlete constantly overstretch (hyperextend) the spine. This can lead to a stress fracture on one or both sides of the vertebra. A stress fracture can cause a spinal bone to become weak and shift out of place.

How is spondylolisthesis treated?

Spondylolisthesis may vary from mild to severe. A person with spondylolisthesis may have no symptoms.

The condition can produce increased lordosis (also called swayback). In later stages, it may result in kyphosis (roundback) as the upper spine "falls off" the lower spine.

Symptoms may include:

  • Lower back pain
  • Muscle tightness (tight hamstring muscle)
  • Pain in the thighs and buttocks
  • Stiffness
  • Tenderness in the area of the spondylolisthesis, at your lower back 

Nerve damage (leg weakness or changes in sensation) may result from pressure on nerve roots and may cause pain that radiates down the legs.

How is spondylolisthesis treated?

Treatment varies based on how severe the condition is. Most people get better with exercises done to stretch and strengthen the lower back.

If the slippage is not severe, you can play most sports if there is no pain. In most cases, you can resume activities slowly. You may be asked to avoid contact sports or to change activities to protect your back from being overextended. You will have follow-up x-rays to make sure the problem is not getting worse.

Nonsurgical treatments are tried first. They may include:

  • Anti-inflammatory medicines to reduce back pain
  • A stiff back brace to limit the spine from being overextended or rotated
  • Physical therapy

You may need surgery to fuse the slipped vertebrae if you have severe pain that does not get better with treatment, a severe slip of the vertebra, or any nerve damage. You may have to use a brace or body cast after surgery. Returning to full sport activity may be possible for some after surgery.

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Review Date: 4/3/2018

Reviewed By: C. Benjamin Ma, MD, Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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