Spondylolisthesis is a condition that can cause chronic low back pain, leg symptoms, and significant functional limitations if left unmanaged. For some people, it goes unnoticed; for others, it can dramatically affect quality of life. Understanding the condition and the available treatment options—both conservative and surgical—can help guide patients toward the best outcomes.

What is Spondylolisthesis?

Spondylolisthesis occurs when one vertebra slips forward over the vertebra below it. The most commonly affected area is the lower lumbar spine, particularly L4-L5 or L5-S1, although it can occur at other spinal levels. The forward slippage may result from a defect or fracture in a portion of the vertebra called the pars interarticularis, which is known as spondylolysis. While spondylolysis is a bony defect, spondylolisthesis refers to the actual slippage.

There are several types of spondylolisthesis:

• Congenital: Present at birth due to abnormal bone formation.
• Isthmic: Often due to a stress fracture in the pars interarticularis (common in younger athletes).
• Degenerative: Most common in older adults due to age-related changes in the joints and discs.
• Traumatic: Caused by acute fractures.
• Pathological: Due to disease processes like tumors or infections.
• Post-surgical: After spinal surgery destabilizes the spine.

How is Spondylolisthesis Graded?

Spondylolisthesis is graded based on how far forward the vertebra has slipped. This grading system is called the Meyerding classification:

• Grade I: 0–25% slippage
• Grade II: 26–50% slippage
• Grade III: 51–75% slippage
• Grade IV: 76–100% slippage
• Grade V (Spondyloptosis): Over 100% slippage—complete displacement

Grades I and II are generally considered stable and are often managed conservatively. Grades III and above are more likely to require surgical intervention, especially if they are unstable or causing neurological symptoms.

Common Symptoms of Spondylolisthesis

Symptoms vary based on the severity of the slippage and whether surrounding structures—like nerves—are affected. Common symptoms include:

• Low back pain, particularly with standing or extension
• Leg pain, tingling, or numbness (sciatica-like symptoms)
• Tight hamstrings
• Pain with activity, especially sports that involve hyperextension (e.g., gymnastics, football)
• Loss of height or posture changes
• Muscle weakness in the legs in more severe cases
• In rare, severe cases: bowel or bladder dysfunction (a medical emergency)

Conservative Treatment Strategies

Most patients with Grades I–II spondylolisthesis can benefit significantly from non-surgical care. Treatment typically focuses on reducing pain, improving mobility, stabilizing the spine, and reducing neural tension.

1. Dry Needling for Pain Relief and Muscle Spasms

Dry needling can be an effective adjunct for managing the muscular component of spondylolisthesis-related pain. Muscles like the erector spinae, quadratus lumborum, and gluteals often become overactive in an attempt to stabilize the segment.

Dry needling helps:

• Reduce muscle tension and spasms
• Improve local blood flow
• Reset dysfunctional neuromuscular patterns
• Decrease referred pain from trigger points

Dry needling is especially helpful when muscular guarding is contributing to pain or limited mobility.

2. Shockwave Therapy for Chronic Pain and Tissue Adaptation

While shockwave therapy is more commonly used for tendon-related issues, it may play a role in addressing secondary pain generators in patients with spondylolisthesis. Chronic muscle tightness, myofascial adhesions, and local ligament irritation (such as the iliolumbar ligament) can respond positively to focused or radial shockwave therapy.

Benefits may include:

• Pain reduction
• Improved blood circulation to stiff or fibrotic tissue
• Myofascial release of chronically tight paraspinals or gluteals

3. Stabilization Exercises to Improve Spinal Support

One of the most important long-term strategies is to strengthen the core musculature to provide dynamic support for the spine. Stabilization exercises should be introduced progressively to avoid overloading the spine.

Key components:

• Transversus abdominis activation
• Multifidus training (critical for segmental stabilization)
• Gluteal strengthening
• Anti-extension exercises like dead bugs, bird dogs, or front planks
• Gradual introduction of hip-dominant patterns like hinges and squats

Working with a skilled personal trainer, physical therapist, or chiropractor familiar with spinal instability is crucial for proper form and progression.

4. Spinal Manipulation to Improve Mobility in Adjacent Segments

While direct manipulation at the level of slippage is generally avoided (to prevent further instability), mobilization or manipulation of adjacent spinal segments—especially the thoracic spine, SI joint, or hip joints—can reduce compensatory stiffness and pain.

For example:

• If L5 has slipped over S1, improving thoracic spine mobility and hip extension can reduce strain on the lower lumbar spine.
• Manipulation can also relieve joint restrictions that exacerbate pain or limit functional movement.

Spinal manipulation should be performed by clinicians trained in assessing stability and spinal mechanics.

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When is Surgery Necessary?

Surgery is typically reserved for patients who:

• Do not respond to conservative treatment over a 3–6 month period
• Have progressive neurological deficits (e.g., worsening leg weakness, numbness)
• Experience significant instability on imaging
• Have high-grade slips (Grade III and above)
• Present with cauda equina syndrome (loss of bowel/bladder function, saddle anesthesia), which is a surgical emergency

Surgical options may include:

• Spinal fusion: Stabilizes the slipped vertebrae using rods, screws, and bone grafts.
• Decompression (laminectomy): Relieves pressure on nerves.
• Interbody fusion (TLIF/PLIF/ALIF): More advanced techniques to restore disc height and stability.

Post-surgical rehab is essential to restore mobility, strength, and function.

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Final Thoughts

Spondylolisthesis can be a challenging condition, but the good news is that most cases can be managed successfully without surgery, especially when caught early. A multidisciplinary approach that includes stabilization exercises, manual therapy, and advanced techniques like dry needling and shockwave therapy can dramatically improve quality of life.

If you’ve been diagnosed with spondylolisthesis or suspect you may have it due to persistent back pain, it’s essential to work with healthcare professionals who can properly assess your condition and tailor a personalized plan to help you move, feel, and live better.

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Need help managing spondylolisthesis?
At Central Ohio Spine and Joint, our team of chiropractors, physical therapists, and personal trainers specialize in evidence-based care for spinal conditions. We’ll create a plan that fits your needs—whether that’s reducing pain, getting stronger, or avoiding surgery. Book an assessment today and start your path to recovery.