Spondylolisthesis

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Diagnosing and Treating Spondylolisthesis

Since there can be so many different causes of back pain, an accurate diagnosis is very important. People usually see their primary care physician or general practitioner first about their back pain; that doctor will probably perform a physical exam first and then order imaging tests to see what’s causing the pain.

X-ray: an X-ray can show which vertebrae have slipped out of place.

Computerized tomography (CT) is a noninvasive procedure that uses x-rays to produce a three-dimensional image of the spine. A CT shows more detail than an X-ray, and can identify any fractures of the bone.

Magnetic resonance imaging (MRI): An MRI uses magnetic fields and radio-frequency waves to create an image of the spine, and can reveal fine details of the spine, including nerves, tumors, and other details. An MRI scan can show details in the spine that can’t normally be seen on an X-ray. Sometimes a contrast agent is injected into a vein in the hand or arm during the test, which highlights certain tissues and structures to make tumor identification clearer.

Myelogram: This test uses a dye that is injected directly into the spinal column, and is used in conjunction with an X-ray or CT Scan.

Once diagnosed, spondylolisthesis is graded based on the degree of the slippage:

  • Grade I — 1 - 25 percent slip
  • Grade II — 26 - 50 percent slip
  • Grade III — 51 - 75 percent slip
  • Grade IV — 76 - 100 percent slip

 
Grades I and II are usually treated initially with conservative and non-invasive measures. Grades III and IV may require earlier surgery, depending on the symptoms (see Surgery for Spondylolisthesis).

Treatment Options

Treatments for spondylolisthesis vary depending on the grade of the slippage, severity of the condition, and the age and health of the patient. Non-invasive, conservative treatment options include:

  • Avoiding heavy lifting or strenuous activities
  • Non-steroidal medications such as ibuprofen to reduce milder inflammation and pain
  • Steroid injections to reduce more serious inflammation and pain
  • Bracing to stabilize the spine and reduce pain

 
Physical therapy to strengthen the core muscles surrounding the spine and encourage newer, pain-free ways of moving. Physical therapy is usually prescribed in approximately 8- to 12-week regimens.)

Surgery: If conservative treatments offer no relief, then surgery may be required. The goal of surgery is to relieve nerve pain, stabilize the spine, and increase a person’s ability to move.

Spine surgery has advanced in recent years so that many procedures are minimally invasive. This type of minimal access surgery causes less trauma than older surgical methods and requires much less time in the hospital. The incision is smaller and avoids muscle trauma, which allows patients to resume regular activity within a short period of time. Surgery for spondylolisthesis is best performed at a major spine center with doctors trained and experienced in the most up-to-date, minimally invasive techniques.  Minimally invasive surgery means a quick recovery, less pain, and less scarring. (See Surgery for Spondylolisthesis.)

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Reviewed by: Eric Elowitz, MD
Last reviewed/last updated: June 2017