Types of spondylolisthesis
- Degenerative: the most common type in adults over 50, caused by arthritis in the facet joints and disc wear, usually at L4-L5.
- Isthmic: caused by a stress fracture (spondylolysis) in a part of the vertebra called the pars interarticularis, often originating in adolescence and typically at L5-S1.
- Traumatic or pathologic: less common, from injury, tumor or other bone disease.
Symptoms
Low back pain, tight hamstrings, and leg pain, numbness or heaviness when standing and walking are typical. Many patients have symptoms of spinal stenosis because the slip narrows the canal.
Diagnosis
Standing X-rays show the slip and its grade; flexion and extension views reveal whether it moves (instability). MRI shows nerve compression. Dr. Ferachi uses these together with your exam to decide whether the spine needs to be stabilized.
Treatment
Many patients do well with physical therapy, activity modification, medication and epidural injections. When leg pain or walking limitation persists, surgery decompresses the nerves and, because the segment is unstable, stabilizes it with a spinal fusion. Dr. Ferachi frequently uses minimally invasive TLIF and percutaneous screw placement, which can reduce muscle damage, blood loss and hospital stay compared with traditional open fusion.
Common questions
Can spondylolisthesis get worse?
Low-grade degenerative slips usually progress slowly, if at all. Symptoms, rather than the X-ray alone, guide treatment.
Is fusion always needed for spondylolisthesis surgery?
Not always, but because the slip reflects instability, most surgeons combine decompression with fusion to prevent further slipping and recurrent symptoms. Dr. Ferachi will tailor the recommendation to your imaging and health.