Spondylolisthésis

Spondylolisthesis is a condition where one spinal bone (vertebra) slips forward or backward out of line relative to the bone below it, most often in the lower back. This sliding can put pressure on nearby nerves and cause back pain, leg pain, or other nerve symptoms, but many cases are mild.​

1) What is this condition?

  • One vertebra moves more than it should and “steps” forward (most common) or backward on the one below, instead of staying neatly stacked.​

  • It can be caused by stress fractures (from spondylolysis), age‑related wear and tear, birth differences, prior surgery, or trauma.​

2) How serious is it?

  • Low‑grade slips (grades 1–2) are common and often cause only back pain or no symptoms at all.​

  • High‑grade slips (grades 3–4) or those pressing strongly on nerves can cause leg pain, numbness, weakness, trouble walking, and, rarely, bladder/bowel issues that require urgent attention.​

3) Non‑surgical treatments

  • Activity changes: avoiding heavy lifting, repeated bending/twisting, and high‑impact sports during flares.​

  • Physical therapy: core and hip strengthening, hamstring stretching, posture training, and graduated return to activity.​

  • Medicines: anti‑inflammatory drugs and other pain relievers; sometimes short‑term muscle relaxants.​

  • Bracing: a lumbar brace in some cases to reduce movement and pain, especially in younger patients or during acute flares.​

  • Injections: epidural steroid injections or nerve blocks to reduce leg or back pain and allow better participation in therapy.​

4) Types of surgery that may be necessary

  • Decompression plus fusion: removing bone/disc pressing on nerves (decompression) and then fusing the slipped segment with screws, rods, and bone graft.​

  • Fusion approaches include from the back, front, or both (posterior, interbody, or combined), chosen based on level, slip grade, and anatomy.​

5) Goals of surgery vs non‑surgical care

  • Non‑surgical goals:

    • Control pain, improve function, and maintain or improve quality of life without the risks of major spine surgery.​

    • Prevent or slow progression of the slip and avoid nerve damage when possible.​

  • Surgery goals:

    • Relieve nerve pressure that causes leg pain, numbness, or weakness.​

    • Stabilize the slipped segment, stop abnormal motion, and, when appropriate, partially correct the alignment.​

6) How surgery can “fix” the problem

  • Decompression removes bone spurs, disc material, or thickened tissue squeezing the nerves in the canal or side openings.​

  • Fusion holds the involved vertebrae rigidly with screws and rods while bone graft heals across them into one solid block, stopping the slip from moving.​

7) Risks of surgery (general and specific)

  • General risks: infection, bleeding, blood clots, lung or heart problems, and anesthesia complications.​

  • Fusion‑specific:

    • Nerve injury causing new numbness or weakness (uncommon, but serious).​

    • Failed fusion (non‑union), in which bones do not fully grow together; this can leave pain and sometimes needs a second surgery.​

    • Reduced motion at the fused level and extra stress on nearby segments that can wear out faster over time.​

8) Chances this surgery will work

  • Reviews show that most patients who need surgery for spondylolisthesis have good pain relief and functional improvement, with high fusion rates.​

  • Fusion is generally preferred over decompression alone when there is clear instability, because it lowers the risk of the slip worsening.​

  • Outcomes are best when surgery is done for clear indications: persistent, function‑limiting pain or progressive nerve problems after solid non‑surgical care.​

9) Possible complications from the surgery

  • Wound problems and infections, sometimes needing antibiotics or additional procedures.​

  • Persistent or recurrent back or leg pain, even when imaging shows a good fusion.​

  • Need for re‑operation in a minority of patients due to hardware failure, non‑union, or new issues at adjacent levels.​

10) Typical recovery from the condition

  • Many people with low‑grade spondylolisthesis manage well with lifestyle changes, therapy, and periodic treatment for flares.​

  • Some remain stable for years; others slowly worsen in pain or nerve symptoms and may eventually consider surgery.​

11) Typical recovery after surgery

  • Hospital stay is usually a few days; walking is encouraged early, but lifting, bending, and twisting are restricted for weeks.​

  • Physical therapy focuses first on safe movement and then on building core and leg strength and endurance.​

  • Fusion healing and full recovery can take 6–12 months, with gradual return to heavier activities as the spine solidifies.​

12) How long in the hospital

  • Many single‑level lumbar fusions for spondylolisthesis require about 2–4 days in hospital if recovery is uncomplicated.​

  • Minimally invasive approaches may shorten this; larger or multi‑level fusions and medical issues can lengthen the stay.​

13) Long‑term outlook

  • Low‑grade slips often have a good outlook with conservative care; many people stay active with manageable symptoms.​

  • After successful fusion for symptomatic spondylolisthesis, most patients report lasting improvements in pain and walking/function, though some residual stiffness is common.​

  • Long‑term, there is a modest risk of new wear and tear at nearby levels, sometimes needing future treatment.​

14) Need for outpatient follow‑up

  • Non‑surgical: periodic visits to monitor symptoms, check for progression, and adjust therapy, bracing, or injections as needed.​

  • Post‑surgery: scheduled follow‑ups with X‑rays/CT to confirm fusion, check hardware, and guide stepwise increases in activity.​

  • Long‑term: reassessment if new leg pain, numbness, weakness, or bladder/bowel changes develop, as these can signal new or recurrent nerve pressure.