Spondylolisthesis
Spondylolisthesis occurs when one vertebra has shifted forward relative to the vertebra beneath it.
It can develop for several reasons, including longstanding pars defects, degeneration, previous injury or structural weakness in the vertebra.
Some people live with a spondylolisthesis for years without significant symptoms. In others it can contribute to persistent lower-back pain, stiffness, nerve irritation, leg symptoms or recurring episodes of mechanical back pain.
The important question is not simply whether a slip is present.
It is whether that slip is stable, whether it matches the symptoms, and whether conservative treatment is appropriate.
What Symptoms Can Spondylolisthesis Cause?
Symptoms vary considerably.
Some people experience mainly lower-back pain or stiffness. Others develop symptoms into the buttocks or legs where the slip or associated degenerative changes reduce the space available for a spinal nerve.
Symptoms may include:
persistent or recurring lower-back pain
stiffness
aching into the buttocks
sciatica or leg pain
tingling or numbness
reduced tolerance for standing or walking
pain associated with extension or particular movements
The degree of slip seen on imaging does not necessarily predict how symptomatic someone will be.
A longstanding slip may remain relatively stable for years, while another patient with apparently modest imaging changes can have significant symptoms.
Why Assessment Matters
Spondylolisthesis is not one single condition.
We want to know:
what type of spondylolisthesis is present
whether there is evidence of a pars defect
how much forward movement has occurred
whether the slip appears stable
whether there is narrowing around the spinal nerves
whether disc degeneration is also involved
how well the imaging matches the patient's symptoms
Existing X-rays, CT or MRI can all provide useful information depending on the presentation.
In some cases, further imaging may be appropriate before treatment is considered.
Can Spinal Decompression Be Used With Spondylolisthesis?
In carefully selected, stable and longstanding cases, spinal decompression may be considered as part of conservative management.
These cases need to be treated differently from a straightforward disc bulge.
In our clinical experience, some longstanding spondylolisthesis patients initially become mildly more symptomatic during the early stages of decompression before subsequently settling and improving.
That early response needs to be interpreted carefully.
We do not simply increase treatment regardless of symptoms. Positioning, settings and progression can be modified according to how the patient responds.
In selected cases, decompression may also be combined with specific chiropractic management directed toward the mechanics of the spondylolisthesis and surrounding spinal segments.
The objective is not to force the vertebra back into a “perfect” position.
The aim is to reduce mechanical irritation, improve function and manage the symptoms associated with the condition.
When Conservative Treatment May Not Be Appropriate
Not every spondylolisthesis should be treated conservatively.
Significant instability, progressive neurological loss, severe nerve compromise or other concerning findings may require specialist assessment.
Where the presentation falls outside what we believe can reasonably be managed with conservative care, we will recommend further investigation or medical or surgical review.
Knowing when not to treat is just as important as knowing when treatment may help.
Start With an Initial Disc Assessment
Your first visit is a dedicated 30-minute assessment with Dr David Kay.
We review your symptoms, neurological findings, spinal mechanics and relevant imaging to determine:
whether the spondylolisthesis is likely contributing to your symptoms
whether the condition appears stable
whether spinal decompression may be appropriate
whether specific chiropractic management may be useful
whether further imaging or specialist referral is required
Initial Disc Assessment — $130
Treatment is not included in the initial assessment.