Spondylolisthesis 

Spondylolisthesis 

Spondylolisthesis can sound alarming, but many people are relieved to learn that surgery is not always necessary, and fusion is not always required. Treatment depends on your symptoms, spinal stability, and daily function. The goal is always the most effective treatment with the least disruption to the spine.

What is spondylolisthesis?

Spondylolisthesis means that one vertebra has slipped forward over the vertebra below it. This can place pressure on nerves and cause back or leg symptoms.
It may develop due to:

• Age-related wear and tear (degenerative)

• A stress fracture or defect in the bone

• Trauma or previous surgery

• Congenital (present from birth) factors

Many people have mild spondylolisthesis and never need surgery.

Common symptoms

Symptoms vary widely and may include:

• Lower back pain

• Pain, numbness, or weakness radiating to the legs

• Difficulty standing or walking for long periods

• Relief of symptoms when sitting or bending forward

Importantly, the degree of slip on imaging does not always match symptom severity.

How is it diagnosed?

Diagnosis involves:

• A detailed clinical examination

• X-rays (often including standing and bending views)

• MRI to evaluate nerves and discs

• CT scans in selected cases

This helps determine whether the spine is stable or unstable, which strongly influences treatment.

Treatment options — not one-size-fits-all

Treatment is always individualized and may include:

Non-surgical treatment

Many patients improve with:

• Activity modification

• Targeted physiotherapy

• Pain management strategies

• Image-guided injections in selected cases

These options are often the first and most effective step.

Surgical treatment (when needed)

If symptoms persist or nerve compression is significant, surgery may be considered. Importantly:

• Fusion is NOT always required

• In many patients, targeted decompression alone can relieve symptoms while preserving spinal motion

• Fusion is reserved for cases with clear instability, progressive slip, or severe mechanical back pain

Minimally invasive, spine-preserving approach

Whenever possible, we focus on:

• Minimally invasive techniques

• Preserving normal spinal structures

• Reducing muscle injury and blood loss

• Faster recovery and return to daily life

The aim is to treat the problem effectively, while being as gentle as possible to the spine.

What matters most

• Not all spondylolisthesis needs surgery

• Not all surgery requires fusion

• Decisions are based on symptoms, stability, and evidence—not images alone

• The best treatment is the one that balances relief, safety, and long-term spine health