What Is Spondylolisthesis & Its Types?
Spondylolisthesis (ICD-10 M43.1) is the forward slip of one vertebra on the one below, most often in the lower back. Many people with a mild slip have few or no symptoms; others develop back pain, sciatica, or leg pain on walking.
In spondylolisthesis, a vertebra slips forward relative to the one below. The slip can narrow the spinal canal and the openings where the nerves leave, and the segment may move abnormally. It is most common at L4–L5 and L5–S1.
Spondylolisthesis involves the forward slippage of a vertebra, potentially causing nerve compression and instability. Medically reviewed by Dr Jaydev Panchawagh, MS (General Surgery), MCh (Neurosurgery), Consultant Neurosurgeon, Pune (Last reviewed: [DD Month 2026]). For educational purposes only; individual outcomes vary and this content is not a substitute for personal medical advice.
Types and Causes
Age-related wear of the disc and facet joints allows slipping, usually at L4–L5 and more often in women over 50.
A stress fracture or defect in a small bridge of bone (the pars) allows the vertebra to slip, usually at L5–S1.
From a developmental anomaly, an injury, or previous spinal surgery.
Video: Spondylolisthesis — what it is and how it is treated, explained by Dr Jaydev Panchawagh, neurosurgeon, Pune.
Symptoms & Grading
Common clinical signs and symptoms include:
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Back pain: Lower back pain, often worse with standing and activity.
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Sciatica: Pain, numbness, or tingling down one or both legs (Read about sciatica).
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Walking difficulties: Leg pain or heaviness on walking that eases on sitting.
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Hamstring tightness: Especially in younger people.
On X-ray the slip is graded by how far the vertebra has moved forward: Grade I (up to a quarter), II (up to a half), III (up to three-quarters), and IV (more). Bending X-rays show whether the segment moves abnormally.
New difficulty passing urine or controlling the bladder or bowel, numbness around the genitals or buttocks ("saddle" numbness), or rapidly worsening weakness in the legs can indicate cauda equina syndrome — a surgical emergency. Go to the nearest hospital emergency department without delay.
Treatment Options
Physiotherapy for core strength, activity modification, medicines, and sometimes injections. Many people with low-grade slips manage well.
In some stable slips with leg symptoms, freeing the nerves alone may be enough. Read about lumbar decompression.
Decompression plus fusion with a cage, screws, and rods. Read about TLIF and spinal instrumentation.
Decompression frees the nerves; fusion stops the abnormal movement. Fusion is added when the slip is unstable or high-grade. The choice should follow the anatomy of your condition, your own circumstances — your health, your work, and what matters to you in recovery — and the advice of your neurosurgeon after examining you and reviewing your scans.
Questions to Ask Your Spine Surgeon or Neurosurgeon
These are the questions patients most often search for after being told they have spondylolisthesis:
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Slip type & grade: What type and grade is my spondylolisthesis?
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Stability: Is my slip stable, or does it move on bending X-rays?
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Progression: Can spondylolisthesis get worse?
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Safe exercise: Which exercises are safe for me?
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Surgical options: Do I need surgery, and would it be a decompression or a fusion?
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Family screening: Should my children or family be checked?
Unless there is an emergency, spine surgery is a planned decision. Seeking a second opinion from a qualified spine surgeon or neurosurgeon before deciding is entirely appropriate.
Frequently Asked Questions
General information only. Please consult a qualified spine surgeon or neurosurgeon for advice about your situation.
Spondylolisthesis is the forward slip of one vertebra over the one below, most often in the lower back. It can narrow the space for the nerves and cause back pain, sciatica, or leg pain on walking, though many people with a mild slip have few symptoms.
The slip is graded on X-ray by how far the vertebra has moved forward: Grade I up to 25%, Grade II up to 50%, Grade III up to 75%, and Grade IV beyond that. Most adults have Grade I or II slips.
Degenerative spondylolisthesis comes from age-related wear of the disc and facet joints, usually at L4–L5 in people over 50. Isthmic spondylolisthesis comes from a stress fracture of the pars, a small bridge of bone, usually at L5–S1 and often starting in youth.
Many low-grade slips stay stable for years. Progression is more likely in children and adolescents with isthmic slips and in some degenerative slips. Worsening pain, leg symptoms, or weakness should prompt review with repeat X-rays.
No. Many people manage well with physiotherapy, activity changes, and medicines. Surgery is considered for persistent disabling symptoms, nerve compression with weakness, or an unstable or high-grade slip.
Spondylolisthesis is managed by physiotherapists and spine specialists. Dr Jaydev Panchawagh—MBBS (B.J. Medical College, Pune), MS in General Surgery (KEM Hospital, Pune), and MCh in Neurosurgery (Seth GS Medical College and KEM Hospital, Mumbai)—is a consultant neurosurgeon in Pune (102, Bhagyatara Society, Erandwane, Pune, Maharashtra 411004; Tel: +91-9011333841) who assesses spondylolisthesis and performs decompression and TLIF fusion surgery when needed.
