Spondylolisthesis Treatment in Castle Rock
What is Spondylolisthesis?
Spondylolisthesis is a condition in which one vertebra slips forward on the vertebra below it. The name comes from the Greek words for spine (spondylo) and slipping (listhesis). The degree of slippage is graded from 1 to 4, with Grade 1 being mild (less than 25% slippage) and Grade 4 being severe (more than 75% slippage). Most patients seen in a pain management setting have Grade 1 or Grade 2 spondylolisthesis.
Spondylolisthesis is common - many people have mild slippage on imaging without knowing it. When it does cause symptoms, patients typically experience back pain that is worse with standing, walking, and extension (leaning back), and in some cases leg pain or numbness from nerve compression caused by the slippage.
What Causes Spondylolisthesis?
There are two main types:
Degenerative spondylolisthesis: The most common type in adults over 50. It develops gradually as the facet joints and discs deteriorate with age, allowing one vertebra to slide forward on the next. It is most common at L4-L5 and is more frequent in women. This type is closely related to facet arthritis and spinal stenosis.
Isthmic spondylolisthesis: Caused by a stress fracture (called a pars defect or spondylolysis) in a small piece of bone that connects the facet joints. This typically develops during adolescence in athletes who perform repetitive extension and rotation (gymnasts, football linemen, dancers) and may or may not cause symptoms later in life. The most common level is L5-S1.
What are the Symptoms?
Low back pain that is worse with standing, walking, and extension (leaning back)
Pain that improves with sitting or bending forward
Stiffness in the lower back
Leg pain, numbness, or tingling if nerve roots are compressed by the slippage
Difficulty walking long distances due to leg symptoms (neurogenic claudication, similar to spinal stenosis)
A feeling of instability in the lower back
How is Spondylolisthesis Diagnosed?
Spondylolisthesis is typically diagnosed on X-ray, which shows the forward slippage of one vertebra on the next. The degree of slippage is measured as a percentage. An MRI may be ordered to evaluate the discs, nerve roots, and facet joints and to determine whether the slippage is causing nerve compression. In some cases, flexion-extension X-rays are obtained to see if the slippage changes with movement (dynamic instability).
How is Spondylolisthesis Treated?
Most patients with Grade 1 or Grade 2 spondylolisthesis can be managed without surgery. Treatment focuses on reducing pain, improving function, and preventing progression.
Physical therapy: Core stabilization and flexion-based exercises are the foundation of treatment. Strengthening the muscles that support the spine helps compensate for the structural instability. Extension exercises and heavy loading should be avoided.
Medications: Anti-inflammatory medications (NSAIDs like meloxicam) and, if nerve irritation is present, nerve-calming medications (gabapentin, pregabalin) can help manage symptoms.
Epidural steroid injections: If spondylolisthesis is causing nerve compression with leg symptoms, epidural injections can reduce inflammation around the compressed nerves and provide relief. The specific type of epidural (transforaminal, interlaminar, or caudal) depends on the location and pattern of nerve involvement. More on the epidural steroid injection page.
Facet joint treatments: Degenerative spondylolisthesis is driven by facet joint and disc deterioration, and the facet joints are frequently a major pain source. Facet joint injections, medial branch blocks, and radiofrequency ablation can provide significant relief for the facet-related component of the pain. More on the facet joint injection page and the RFA page.
SI joint treatment: L5-S1 spondylolisthesis in particular can alter the mechanics of the sacroiliac joints. If SI joint pain is contributing, targeted injections can help. More on the SI joint injection page.
When is Surgery Needed?
Surgery (typically a spinal fusion) is considered for spondylolisthesis with progressive neurological symptoms (worsening weakness or numbness), high-grade slippage (Grade 3 or 4), significant instability on flexion-extension X-rays, or severe symptoms that have not improved with an adequate trial of non-surgical treatments. Dr. Carrera's team works closely with spine surgeons to determine when surgery is the right path versus continuing with interventional pain management.
Schedule an Evaluation
If you have been diagnosed with spondylolisthesis and are experiencing back or leg pain, Dr. Carrera's team can determine which structures are contributing to your symptoms and whether non-surgical treatment can help. Most patients with Grade 1 or Grade 2 spondylolisthesis can be managed effectively without surgery.If you have been diagnosed with spondylolisthesis and are experiencing back or leg pain, Dr. Carrera's team can determine which structures are contributing to your symptoms and whether non-surgical treatment can help. Most patients with Grade 1 or Grade 2 spondylolisthesis can be managed effectively without surgery.