Spondylolisthesis: when one vertebra slips over another
Diagnosis and treatment of vertebral slippage in Valencia — from specific exercise to minimally invasive surgery.
Spondylolisthesis is the slippage of one vertebra over the one below, almost always in the lower lumbar spine (L4-L5 or L5-S1). It may be due to a defect of the vertebral arch of juvenile origin (isthmic spondylolisthesis) or to degeneration of discs and joints over the years (degenerative, the most common after age 50).
What symptoms does it cause?
Mechanical low back pain
Worse standing and walking, better sitting or lying down.
Sciatica
Pain radiating to one or both legs from root compression.
Claudication
The need to stop while walking, similar to spinal stenosis.
Sense of instability
“Clicks” or a feeling that the back “gives way” with certain movements.
Grades and diagnosis
The slippage is classified into grades (Meyerding I to IV) according to the percentage of displacement. The X-ray identifies it; dynamic X-rays (in flexion and extension) reveal whether the slippage is stable or moves; the MRI shows root compression and disc condition. This distinction —stable vs. unstable— is the key to the entire treatment.
Treatment
1. Conservative (first line in low grades). Deep core strengthening, weight control, physiotherapy and analgesia. Most stable grade I–II cases are managed without surgery for years.
2. Injections. Useful for radicular pain during flare-ups, always image-guided.
3. Surgery. Indicated with documented instability plus disabling pain, neurological deficit or progressive claudication. Depending on the case: decompression of the roots —which in stable slippage can be performed via minimally invasive technique without fusion— or fusion (arthrodesis) when instability demands it. Choosing correctly between the two is exactly the kind of decision where experience matters.
Frequently asked questions
Degenerative ones usually progress very slowly and many stabilize. Follow-up with comparative X-rays confirms this.
Generally yes, adapting it: strengthening the core is protective. Repetitive-impact or hyperextension sports are assessed individually.
No. In stable slippage with root compression, decompression without fusion is a valid and far less aggressive option. Fusion is reserved for real instability.
Have you been diagnosed with spondylolisthesis?
Not all of them need surgery. Dr. Vilatela reviews your MRI and dynamic X-rays and guides you on the right path for your grade and symptoms.