Retrolisthesis and Spine Surgery

Retrolisthesis is a backward movement of a spinal vertebra relative to the vertebra beneath it. Historically, retrolisthesis has been seen as having no clinical significance. But as research activities continue, associations with pain, decreased functionality, and degenerative changes in the spine are being made.

For example, a 2003 study published in The Spine Journal found that African American women had 2 to 3 times more anterolisthesis (forward vertebral slippage) than their Caucasian counterparts. The anterolisthesis did not negatively affect their back function. The same study also found that retrolisthesis (backward vertebral slippage) was much less prevalent in this same community (4%) but did decrease the participants' back functioning.

A study published in the March 2015 issue of the Journal of the Korean Neurosurgical Society identified retrolisthesis as compensation that moves a vertebra backward when your spine and pelvis are biased too far forward in the forward/backward plane. The researchers say that a small degree of lumbar lordosis and/or a small pelvic tilt angle can instigate the formation of a retrolisthesis.

Back Surgery and Retrolisthesis

In a 2007 study published in Spine Journal, researchers evaluated 125 patients who underwent an L5-S1 discectomy. Their goal was to look for the presence of retrolisthesis. They found that almost 1/4 of the patients in the study had this backward slippage of L5 over S1.

If you have retrolisthesis, these results don't automatically mean you'll have more pain than someone who doesn't. The researchers found that prior to the discectomy, symptoms experienced by both groups (i.e., with and without retrolisthesis) were about equal.

The researchers also examined changes in spinal structures accompanying retrolisthesis cases. Overall, they found that the presence of retrolisthesis did not correspond with a higher incidence of degenerative disc disease or degenerative changes in the bony ring in the back of the vertebra.

Retrolisthesis can occur because of surgery. Another study, published in Spine Journal in 2013 found that 4 years after a discectomy, pain from retrolisthesis either presented itself for the first time or got worse. The same was true for physical functioning.

Much like the Dartmouth study, outcomes of the patients with retrolisthesis who underwent the discectomy were comparable to those of patients without it. This time, though, the outcomes included time in surgery, amount of blood loss, time spent in the hospital or outpatient facility, complications, need for additional spine surgery and/or recurrent disc herniations.

Yet another study (published in the December 2015 issue of the Journal of Neurosurgery: Spine) found that surgery may not be appropriate for patients who had greater than 7.2% retrolisthesis while in extension (back arching). The reason was that retrolisthesis in these cases increased patients' risks for post-surgical lumbar disc herniation. (The surgery in question was a bilateral partial laminectomy, along with the removal of the posterior support ligament.)

Who Gets Retrolisthesis?

So what kind of patient gets retrolisthesis? The 2007 study mentioned above found that the presence of retrolisthesis was consistent across all types of patients - whether they were old, young, male, female, smokers or not, educated or less so, and regardless of race.

That said, people with retrolisthesis were more apt to be receiving workers comp. And age was a factor in those who had vertebral endplate changes and/or degenerative disc disease (both with and without retrolisthesis). This may be because, generally, such changes are age-related.

And finally, study participants who had vertebra endplate changes tended to be smokers and also tended not to have insurance.