Spondylolisthesis is a condition in which a vertebral body slips anteriorly in relation to the subjacent vertebrae. The condition affects up to 10% of the population. The two most common forms of spondylolisthesis are isthmic and degenerative. Isthmic spondylolisthesis is associated with a disruption of the vertebral ring and most commonly occurs at L5–S1. This form is most prevalent in children and adolescents and is often associated with repetitive hyperextension of the spine (e.g., in gymnasts). Degenerative spondylolisthesis occurs at L4–L5 and most commonly affects individuals over 50 years of age. Other forms of spondylolisthesis may be associated with congenital disease, trauma or bone fractures, and underlying bone pathology (e.g., Paget disease). Spondylolisthesis may be asymptomatic or cause lumbar pain on exertion, gait problems, radiculopathic pain, or urinary incontinence. Some patients have a palpable step-off sign at the lumbosacral area. Diagnosis is established with imaging. Most patients achieve good symptomatic control with conservative treatment (e.g., physical therapy). Surgical treatment (e.g., vertebral fusion, decompression laminectomy) is reserved for patients with refractory symptoms and/or neurological deficits. Overall, children and adolescents have better outcomes than adults and elderly patients.
- Spondylolisthesis: anterior slippage of a vertebral body over the subjacent vertebra
- Isthmic spondylolisthesis (spondylolytic form): spondylolisthesis resulting from an abnormality in the pars interarticularis 
- Degenerative spondylolisthesis: spondylolisthesis resulting from degenerative changes, without an associated disruption or defect in the vertebral ring 
- Congenital spondylolisthesis: spondylolisthesis secondary to congenital anomalies (e.g., hypoplastic facets, sacral deficits, poorly developed pars interarticularis).
- Affects up to 10% of the population
- Most common in children and adolescents < 18 years (congenital and isthmic spondylolisthesis) and adults aged > 50 years (degenerative spondylolisthesis)
- Sex: ♂ > ♀ (congenital and isthmic spondylolisthesis); ♀ > ♂ (degenerative spondylolisthesis)
- Defect most commonly occurs in the lumbar spine (typically L5-S1 in isthmic spondylolisthesis, L4-L5 in degenerative spondylolisthesis) 
Epidemiological data refers to the US, unless otherwise specified.
Risk factors include:
Congenital malformation (dysplasia or hypoplasia) of the lumbosacral joints in L5–S1
- Repetitive hyperextension and rotation movements at L5–S1
- Commonly associated with gymnastics, swimming, and weight lifting
- Spondylolysis: lytic defect in the pars interarticularis, permitting forward slippage of the superjacent vertebra 
- Degenerative disease: most commonly in the elderly at L4–L5
- Local or systemic pathology (e.g., tumor, , , )
The severity of symptoms often correlates with the degree of vertebral slippage. 
- Asymptomatic (majority of patients) 
- Acute or chronic lumbar pain that worsens with activity and/or with spine extension 
- Gait problems (e.g., waddling gait, )
- Other features of neurological involvement include : 
- Urinary or bowel incontinence
- in severe cases
- Possible physical examination findings 
- Lower limbs
- Consider in patients with characteristic clinical features; in asymptomatic patients, the diagnosis may be incidental.
- Imaging studies confirm the diagnosis, help monitor progression, and are needed to guide the treatment.
Spondylolisthesis is often an incidental finding.
- Indications: initial test for all patients in whom spondylolisthesis is suspected
- Supportive findings: anterior vertebral displacement ( ) 
- Additional findings
Meyerding classification 
|V||> 100%, referred to as spondyloptosis|
Additional imaging studies 
- Options 
See also “Differential diagnosis of lower back pain.”
Facet joint syndrome
- Irritation of the facet joints, usually due to spondyloarthritis
- Symptoms can be nonspecific but often include radiating pain to the buttocks or groin
- It is differentiated from other spinal pathologies (especially discogenic pain) by the fact that pain is not exacerbated with increased intra-abdominal pressure (e.g., Valsalva maneuver)
The differential diagnoses listed here are not exhaustive.
- Treatment goals are to reduce pain, restore mobility, and prevent disease progression.
- Conservative treatment can be attempted initially in most patients.
- Surgical treatment is usually reserved for patients with high-grade slippage or persistent symptoms.
Immediate surgery consultation is required for patients with motor deficit or to evaluate the need for emergency surgical decompression. 
Conservative treatment 
- Initial treatment for patients with low-grade slippage and no significant neurological involvement
- Consider as initial treatment for high-grade degenerative spondylolisthesis with no significant neurological involvement. 
General recommendations 
- Physical therapy: e.g., bracing, back-strengthening exercises 
- Physical activity restriction: e.g., 1–2 days of rest during acute symptoms, stopping sports that contribute to spondylolisthesis
- Management of comorbidities that might contribute to symptoms and disease progression: e.g., or 
Surgical treatment 
The best surgical approach and indications should be discussed in consultation with a specialist.
- Common indications
- Treatment options
- Conservative treatment gives satisfactory results in 80% of cases.
- The rate of success from surgical treatment is higher in children than in adults.