Lumbar Spondylolisthesis

Overview

Lumbar spondylolisthesis, or bone slip, is when one vertebra is shifted relative to another vertebra, most commonly in the lower spine. When there is a spondylolisthesis at L4-5, it is usually due to lumbar degenerative disc disease associated with back and leg pain. Pain in the leg can be unilateral or bilateral.

When there is a spondylolisthesis at L5-S1, it is usually due to lumbar spondylolysis of the pars of L5. The pars interarticularis, or pars, is a segment of bone that attaches the vertebral body pedicle to the inferior articulating facet joint. In a patient with a pars defect, they are usually born this way and can worsen over time to cause a slip.

As the bone slips, the associated degenerative tissue can compress the L5 nerve, causing pain or foot drop. The patient may also have back pain with unilateral or bilateral leg pain and weakness. A spondylolisthesis at L5-S1 is called an isthmic spondylolisthesis and affects approximately five to seven percent of the population. A spondylolisthesis at L4-5 is called a degenerative spondylolisthesis.

Both types can be painful and present with back pain, leg pain, or both. If a patient develops a foot drop or other leg weakness, conservative care will be initiated. If the weakness persists, your surgeon may strongly consider surgical decompression.

Symptoms

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Causes

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When to see a specialist

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Non surgical treatment options

We offer comprehensive non surgical treatment plans tailored to each patient's condition, focused on pain relief, mobility improvement, and overall spinal health. While we do not perform these treatments in house, we collaborate with trusted local specialists to ensure you receive the highest level of care.

Physical therapy

We develop personalized physical therapy prescriptions based on your specific needs and refer you to experienced local providers. These programs are designed to improve strength, flexibility, and posture, helping to reduce pain and enhance mobility while promoting long term spinal health.

Epidural injections

For patients who may benefit from epidural steroid injections, we provide expert evaluations and referrals to trusted local physicians who specialize in pain management. These injections can reduce inflammation and nerve related pain caused by conditions such as herniated discs and spinal stenosis, offering significant relief with minimal downtime.

Chiropractic care and acupuncture

Chiropractic care can help patients with leg pain as a component of their condition. Acupuncture works best in the presence of severe muscle spasms. Both are considered alongside physical therapy and medication as part of a comprehensive conservative plan.

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Common treatments include non steroidal anti inflammatory agents, physical therapy, and epidural injections. Acupuncture and chiropractic care can help as well.

Surgical options

Patients are initially evaluated by a physiatrist to ensure all non surgical options, including physical therapy and non narcotic pain management, are exhausted before considering a surgical solution.

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Surgery usually requires at least a single level fusion, or TLIF, with pedicle screws and an interbody cage. The goal is to decompress the compressed nerve root. Because the level is considered unstable, most surgeons fuse with pedicle screws and an interbody cage.

Recovery

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