Spondylolisthesis (Slipped Vertebra)

Spondylolisthesis means one vertebra has slid forwards over the one below it. It happens most often at the bottom of the lumbar spine, between L4 and L5 or L5 and the sacrum. It is not the same as a slipped disc, which is a bulge of the soft cushion between the bones.

Many slips are small, stable and found by chance on an X-ray. Others narrow the canal or the side openings where nerves leave the spine and cause back pain, sciatica or heaviness in the legs on walking. The degree of slip on imaging matters less than the symptoms it produces.

Symptoms

• Low back ache that is worse when standing or arching backwards
• Pain, tingling or numbness running into one or both legs
• Heaviness or cramping in the legs after walking a set distance, eased by sitting or bending forwards
• Tight hamstrings and a stiff, short-stepped walk
• A visible step or increased hollow in the lower back in larger slips
• No symptoms at all in many low grade slips

Causes and risk factors

In teenagers and young adults the usual cause is a stress fracture of a small bridge of bone called the pars, often linked to sports with repeated back extension such as gymnastics, cricket bowling or weightlifting. In people over 50 the common form is degenerative: worn facet joints and discs let the vertebra drift forwards, more often in women and at L4 to L5. Rarer causes are a birth variant in the shape of the joints, a major injury, a tumour or infection weakening the bone, and previous spinal surgery that removed too much supporting bone.

How it is diagnosed

• Standing X-rays: Side views show the slip and grade it from 1 to 4 by how far the bone has moved. Bending views show whether the segment moves abnormally.
• MRI scan: Shows which nerves are squeezed, the state of the discs and whether there is narrowing of the spinal canal.
• CT scan: Gives the clearest picture of a pars fracture and of bone anatomy when surgery is being planned.
• Neurological examination: Checks strength, reflexes, sensation and walking distance, which guide treatment more than the image does.

Treatment options

• Activity change and physiotherapy: Core and hip strengthening, hamstring stretching and a break from the provoking sport settle most low grade slips over 3 to 6 months.
• Pain relief: Short courses of anti-inflammatory medicine, used alongside exercise rather than in place of it.
• Spinal injections: Epidural or nerve root steroid injections can ease leg pain for weeks to months. They do not change the slip.
• Bracing in young athletes: A brace for some weeks may be used for a fresh pars stress fracture to give it a chance to heal.
• Decompression surgery: Removes bone and ligament pressing on nerves. On its own it suits only selected stable slips.
• Spinal fusion: Screws, rods and bone graft lock the slipped segment, usually combined with decompression. It is considered when leg symptoms or disabling pain persist after months of good conservative care, or when the slip is progressing.

When it is urgent

Seek emergency care where you are if you develop numbness around the genitals or back passage, new difficulty passing urine or controlling your bowels, or rapidly worsening weakness in a leg or foot. These can signal cauda equina compression, which needs surgery within hours and is not something to fly with.

Travelling to Türkiye for treatment

Spondylolisthesis is rarely urgent, which makes it suitable for a planned second opinion. Send your standing X-rays and MRI ahead so a spinal surgeon can say whether surgery is advisable at all. If fusion is agreed, expect roughly 10 to 14 days in Istanbul, with a few nights in hospital. Physiotherapy over the following months and the follow-up X-rays that confirm the bone has fused need to be arranged at home before you leave.

Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.

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