Physiotherapy Q&A: can you tell me what spondylolisthesis is and whether I will need surgery

I recently saw a chiropractor as I have been having ongoing low back pain (LBP) for a number of years and it is getting a little worse. She said it appears I have spondylolisthesis and that I may need surgery. This has really worried me. Can you advise me what exactly spondylolisthesis is and whether I will indeed need surgery?

There are many specific and non-specific causes for LBP. Spondylolisthesis is one example of a specific cause which is actually relatively rare given that some 90% of LBP is non-specific. However, spondylolisthesis refers to a slipping of part or all of a vertebrae (the bones that form the spine) forward on another. There are many different causes for this and some develop in early childhood with the extra stresses and strains we put through our backs, for example during sporting activities. Many people actually never know they have it, demonstrating that Spondylolisthesis is often non-painful and in fact often found incidentally. However, spondylolisthesis like any condition can range from mild, moderate to severe.

The most common symptom of spondylolisthesis is likely to depend on the grade or severity. Often mild spondylolisthesis is non painful. Higher grades may cause LBP alone or LBP with leg symptoms too. The pain is normally aggravated by activities such as standing and walking, however, lots of other causes of LBP are aggravated by these activities too. Diagnosis of a spondylolisthesis is firstly based on clinical history and assessment, often with an X-Ray then used to confirm the condition.

If you are one of the minorities who is confirmed as having spondylolisthesis that is likely to be causing your symptoms then there are various treatment options. Mild spondylolisthesis often responds well to rest from aggravating activities and strengthening exercises focusing on your core stability muscles to increase the stability of your spine. Hands on treatment by a trained clinician such as a Physiotherapist may also be helpful to mobilise other stiff levels around the symptomatic one. As soon as symptoms calm down and the core stability muscles are adequately stabilising the spine then a return to previously aggravating activities is normally well tolerated. In those with more severe forms of spondylolisthesis treatment still depends on how symptomatic the condition is. It is very rare for the slip to progress which is very reassuring. However, like with any condition a small number end up going on to have spinal surgery to ensure the spine remains nice and stable. However, you would certainly be in the minority if you got to this stage rather than in the majority!

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