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Degenerative lumbar spondylolisthesis is the slipping forward of one of the vertebrae found in the low back.
Illustration:
Anne Asher

Recently the North American Spine Society updated their guidelines (suggestions to doctors on how to understand, diagnose and treat medical problems) for degenerative lumbar spodylolisthesis. Spondylolisthesis is a fancy way of saying 'slipped vertebra' (but is not the same as 'slipped disk', mind you). They arrived at their conclusions by assembling a team of reviewers to read the latest research in this area. The great thing about guidelines such as this one is that the suggestions found within are based entirely upon the results from medical research; in other words, the reviewers have located evidence that the treatments, etc. they suggest really do work, along with the degree to which they work, based on the quality of the studies they consult. The guidelines are current up to June 2007.

The reviewers were looking for answers to specific questions that will help health care providers with key issues. They were interested in things like how degenerative lumbar spondylolisthesis shows up (for example, which symptoms might be clustered together, and why) when and what type of surgery might be useful, what makes the slippage progress and what doesn't, and when conservative care would be all the treatment you would need.

Here are a few of their findings:
Lumbar degenerative spondylolisthesis is the slipping forward of a low back vertebra (over the one below it). Symptoms vary and it's possible to have spondylolisthesis without experiencing any back pain, leg pain or other associated problem at all. If you do not have neurological symptoms such as muscle weakness or cauda equina syndrome, it is quite possible conservative care may be all you need for your well-being. If you do have neurological symptoms, you may find that you will need surgery to prevent a decline in your ability to function in your everyday activities.

The reviewers also found that once the intervertebral disk has lost more than 80% of its original height, the forward slipping doesn't happen as much. They think that perhaps the presence of bone spurs, hardened ligaments and similar spinal changes provide some stabilization to the area.

Spondylolisthesis is what they call an anatomical finding. According to the guidelines, the best way to locate it is with an X-ray taken from the side. But sometimes spinal stenosis comes with spondylolisthesis, and in this case MRIs, myelographs or CT myleographs will help the doctor to better visualize the problem.

If you would like to read the guidlines in depth, you can download the report at the NASS website.

Comments
July 10, 2008 at 9:48 am
(1) David Miller says:

My aunt has had terrible back pain for over a year and has refused surgery even though it was recommended. In some cases, I think surgery really is the only effective option, in order to really relieve the pain. Drugs should not be used as a primary treatment, just temporary. Thanks for this important article.

July 11, 2008 at 11:29 am
(2) Rain says:

Wow, what a thorough report, Anne! My father was in a motorcycle accident some years back and has since suffered back pain. I’m going to pass your site address on to him. Thanks!

July 11, 2008 at 12:39 pm
(3) elaine Lemm says:

Hi Anne
I have had a doctors appointment this week for a rather uncomfortable numbness down my right leg. She is sending me for an MRI scan on my back to check out my disks….scary, Never had any problems until my new job which involves siting for long hours in front of a computer screen!

July 11, 2008 at 12:47 pm
(4) Anne says:

Hi, Elaine,
Wow. Sorry to hear about the negative effects of your new job. This is just my personal opinion, but I have always thought that sitting is one of the worse things we humans do to our back on a regular basis. Good luck with the MRI and treatment.
Anne

July 11, 2008 at 3:37 pm
(5) Nancy says:

Fascinating info. I think science is wonderful. Back pain is so devastating, and I am glad that the reams of reports are reviewed and scrutinized by spine experts. This will help us all, for sure!

July 12, 2008 at 9:57 am
(6) Deb says:

Elaine, I’m experiencing the same thing, although I know my problem is that my SI joints stick. Yoga is my cure. I just have to get myself on the mat!

July 12, 2008 at 3:21 pm
(7) Wendy says:

What an incredibly thorough post – I’m going to forward this to my mom, she suffers from this.

November 18, 2010 at 12:13 pm
(8) Peggy says:

My relief for this condition came from a chiropractor. I had never been to a chiropractor before but I was desperate because my orthopedic doctor just kept giving me cortizone shots (3) and they gave me no relief. My chiropractor explained that cortizone would not help because my problem was structural. Over 10 sessions the chiropractor very graually moved my vertebrae back into place. This has to be done gradually to give the nearby muscle the opportunity to move in and hold the vertebrae in its corrected position. The intense pain in my left leg that kept me awake at night has subsided greatly and I can now sleep through the night. Daytime pain has subsided as well. Chiropractor said I will likely need an “adjustment” every 6 – 8 weeks to keep it like this. I strongly suggest trying chiropractic treatment but you have to be patient!

November 26, 2010 at 3:21 pm
(9) Em says:

I have been diagnosed with this HORRIBLE condition from a chiropractor that said he could NOT help me with it. I am already progressed to such a degree (he took x-rays) that I am definately a surgical candidate but I am so afraid to have the surgery but am only 49 and it has vastly changed my quality of life already!

May 23, 2011 at 9:02 pm
(10) David says:

I avoided a head on collision when another vehicle lost control, crossed over the interstate median and I managed to change lanes bu still struck his trailer and ended up rolling my semi and trailer. Not until 3 days later did I realsize this was something that was’ nt going to heal with time. L5S1 injury. No longer can drive a truck since it really is painful in the seated position.

June 14, 2011 at 5:27 pm
(11) Susan says:

I have a 20 percent slippage at my last two vertebre. Have been going to the pain management dr. Had three epideral treatments, and am on STRONG pain meds. I got releif on my right side but the left bothers me intensly. I sleep with a pillow betwee my legs to get releif at night. According to wihat I’ve read I shouldn’t have this much discomfort with a 20 percent slippage. I am 69 yrs old, but I will do anything I can to be able to move without this pain. It frightens me that it might get worse and I will become wheel chair bound.
My doctors have not been very informitive. They tell my to be patient. Your article gave me a little insight into what it happening. Any thing more you can tell me I would certainly appreciate.

July 8, 2011 at 12:48 pm
(12) Karen says:

I had surgery two years ago. I was reluctant because I had heard so much negativity. But I did it anyway. My only wish is that I had done it sooner. Even though I still deal with arthritis pain in back area, the surgery was definitely a help. I should have had it done much sooner. I am now able to walk for a mile a day, something that previously unheard of and am able to control the pain with aspirin, as long as I do not stand too long or do too much.

Thank God for doctors and modern medicine

August 6, 2011 at 2:01 pm
(13) SantaFE says:

My first post ! :)

January 3, 2012 at 5:35 pm
(14) allen says:

if anyone can give me some advise id greatly appriciate it im 24 years old i got into a head on collision and i had extreme tension and swelling in my lower back like right between the top of the cheeks lol it hurts to sit and to even walk went to the ER and they told me that i had a slipped verterbrae and that i have spinal bifida kinda blind sided me im on no medication because it was just found and i dont know the extent of my problem is i dont know what a slipped vertibrea is nither do i kno anything about spinal bifida can someone help me at all understand

April 27, 2012 at 5:43 am
(15) tracy says:

Diagnosed with slipped vertebra in 2011, but it started in 2008 after I fell at work. Employer refused to cover it…which has made my life hell as everyone says sounds like workers comp. But since the 20% slippage is stable says the Dr. he doesn’t recommend surgery. The pain is really bad down one leg and my whole life has changed because of the constant pain. I can no longer work. Home tasks are very difficult also. I had the Epidorial injection last fall but it didn’t help. even though the Dr. ordered the injection my insurance is not wanting to cover it. I haven’t found anything to help with the pain. Physical Therphy didn’t help either. I feel life is ruined for me and I’m only in my 50′s.I really got a bad deal from my employer when they got out of covering this injury. How they did, I don’t know.My once active life has turned completely into an almost standstill. I don’t know what to do.

April 6, 2013 at 4:41 am
(16) Ranganath says:

I am diagnosed with sliped vertibrae and also disc compression and I have been advised surgery. I am having pain in both calf muscles all the time. It get worse in the night. Iam unable to sleep. If I under go spinal fusion , what time it generally takes recover so that I can live a normal life. I am 71 years old. L4 and L5 needs to be fussed.

January 16, 2014 at 5:06 pm
(17) Delores says:

Anne, what a thorough article. I was diagnosed with fibromyalgia by one rheumatologist and then diagnosed by another rheumatologist who said that I had cervical Spondylosis to avoid the fibromyalgia diagnosis. All I know is that I am in constant pain everyday. All of my symptoms are those of fibromyalgia and that is what I go with. My pressing issue is the constant pain in my neck. It’s never ending. I’ve done everything possible except surgery. Who should I consult regarding options for surgery? Like one of the other people that commented injections, physical therapy, chiropractor, medication, nothing has helped. Thank you

March 27, 2014 at 9:10 pm
(18) Callie Butler says:

Just found out I have stage 2 spondylolisthesis and very worried. Im not the type to stay still and dont want surgery. What can I do to keep in shape and from surgery.

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