What it is
Spondylolisthesis means one vertebra has shifted forward relative to the one below it. It ranges from mild, stable slips found incidentally on imaging to unstable segments compressing nerves. Degenerative spondylolisthesis (from arthritic change, most common after 50) and isthmic spondylolisthesis (from a small stress fracture, often acquired in youth) are the most frequent types.
Common symptoms
- Lower back pain, worse with standing or extension
- Leg pain, numbness, or heaviness when the slip narrows the nerve canals
- Difficulty standing for long periods
- Hamstring tightness
Why it happens
Arthritic facet joints and degenerated discs lose their grip on alignment; a pre-existing stress fracture can do the same. Many slips remain stable for life. The evaluation — standing X-rays, sometimes flexion-extension views, and MRI — determines the grade, the stability, and whether nerves are compressed.
How Dr. Pompliano evaluates it
Every evaluation starts with listening — a detailed history of your symptoms, how they behave, and how they limit your life — followed by a focused physical and neurological examination and a careful review of your imaging. The diagnosis drives the plan, not the other way around.
Treatment: conservative first
Most patients with this condition improve without surgery. Depending on your specific situation, a plan may include:
- Core-focused physical therapy: stabilization programs are the backbone of non-operative care
- Activity modification: temporary reduction of extension-loading activities during flares
- Medication: short courses for symptomatic periods
- Epidural or facet injections: for radiating leg symptoms or facet-generated pain
Surgery is recommended only when symptoms persist despite a genuine course of conservative care, or when there are signs of progressive nerve or spinal cord compromise.
When surgery makes sense
Surgery is considered for slips that are unstable, progressing, or compressing nerves despite conservative care. The standard operation is a decompression with fusion of the slipped level — frequently performed minimally invasively.
Related procedures: TLIF · Posterior Decompression · ALIF