Many patients with spondylolisthesis have no or mild symptoms. However, some experience low back pain, sciatica or symptoms of spinal claudication. In rare cases it can lead to incontinence due to pressure on the bowel and bladder nerves (cauda equina syndrome).
In some cases the slippage gradually progresses although apart from a very few exceptions (traumatic spondylolisthesis) the spine is not unstable. Prolonged pressure on nerves can damage these and lead to neuropathic pain. The patient experiences a burning sensation in the leg or foot. Once this has occurred it is often difficult to treat. A significant neurological deficit like weakness is uncommon.
A thorough history of the symptoms is important to obtain information about the development of the problem. Clinical examination will assess possible sources of the pain and any neurological deficit. Plain x-rays and flexion / extension views will show the degree of slippage and determine whether the slip is stable or not. Special x-rays (oblique views) can show the pars defect. In patients who have symptoms of spinal claudication or sciatica, MRI should be done to see if there is pressure on any nerve. In some cases a CT scan is necessary to look at the bony anatomy in more detail.
Treatment and Outlook
Treatment and outlook depends on many factors like degree of slippage and progression, underlying type and how much problems it is causing for the patient. All patients should be referred for physiotherapy focusing on cores stability exercise. However, physiotherapy will not reverse or even prevent progression of any slippage but can lead to significant improvement of back and leg pain. Spinal manipulation cannot reduce the slippage. Spinal injections (facet or epidural injections might temporarily improve back or leg pain but should not form part of a long term management plan except in a few exceptional cases.
Surgical options include decompression and fusion of the spine (spinal fusion). Which surgical procedure is chosen depends on a number of factors. Most spine surgeons will probably advocate a pedicle screw fixation and (if possible) interbody cage (PLIF,TLIF, XLIF).