Spondylosis and Spondylolisthesis

Spinal bones are aligned being one on top of other in an order. Normally, front and back edges of vertebrae are in same alignment with the edges of previous and next vertebrae. The vertebrae are attached to each other through discs at the front and facet joints at the back. Many ligaments form a bridge between the bones to enhance strength of this alignment. Spondylolisthesis means forward displacement of one vertebra over the vertebra below. With slippage, spinal cord in the spine is compressed, resulting in pain, numbness and burning sensation in the legs. It is categorized into five different types.

The most common ones include slippage related to degeneration in old ages; slippage developed postoperatively, and slippage related to congenital problems of vertebrae in childhood. 5% of people have a developmental fracture on bony section attaching upper and lower joints (facet joints) of vertebrae located on the low back. This fracture is called “spondylolysis”. The fractures are mostly unable to union since this area is very moving.

However, this fracture usually causes pain in adolescence period but may not result in serious problems in adulthood period. In some patients, the upper vertebra is displaced forward over the vertebra below due to fracture. This is referred to as “lumbar slippage” or “spondylolisthesis”. Spondylolisthesis can lead to more serious problems depending on the size of slippage. This kind of lumbar slippages related to fracture is medically called “isthmic spondylolisthesis”. Another type of lumbar slippage is due to wear and tear of ligaments in and around the spine due to ageing. This problem that often occurs over 40 years old is referred to as “degenerative spondylolisthesis”. Degenerative lumbar spillages are usually accompanied by narrowed canal. Stress fractures (spondylolysis) may not be always presented with clinical signs.

Sometimes it is incidentally discovered by a lumbar radiography taken for other reasons. If the pathology becomes symptomatic, the initial complaint is often lumbar pain. Lumbar slippages might not display any signs even after years of occurrence of slippage. The symptoms include back and hip pain; numbness, pain, muscle strain, weakness in the legs; increased lumbar curvature, or difficulty in walking. Even though resting can provide a temporary relief of these symptoms, the pain is usually increased with standing up, walking and other activities.


The diagnosis involves a detailed physical examination of patients. In case of slippages causing compression on nerves, the pain and numbness history of patients will help experienced physicians with diagnosis. Again, neurological examination of patients provides information about slippage region.

Radiographic tests are highly important in diagnosis of lumbar slippages. Whether slippage is reduced or increased with lumbar movements is significant to the physicians to determine the treatment method. This is identified by radiographies taken with patients bending forward or backward.

Stress fractures are often not possible to be identified by a plain radiography. A computerized tomography will be appropriate for suspected cases. The final diagnosis of nerve compression related to slippage and stenosis of spinal canal is made by MRI (magnetic resonance). Your doctor may request EMG (electromyography) test when necessary.


Stress fractures and lumbar slippages not causing a complaint should be followed. In case of mild slippages, the complaints will be relieved by one or more of the methods such as resting, analgesics and anti-inflammatory drugs, temporary use of a corset, and physical therapy. If back pain is accompanied by leg pain and numbness associated with nerve compression, epidural or foraminal injections can be considered.

If adolescence stress fractures result in pain and restricts activity of juveniles, they should have a surgical treatment. The most appropriate method is determined by your doctor. The preferred method is usually to support with fresh bone grafts for fusion of fractured area and to fix with screws and hooks. The experienced physicians at our clinic will perform this operation even only for one vertebra. So, short term recovery is achieved and our patients get their usual activities without any restrictions of lumbar movements.

In case of slippage in advanced ages, if the disease causes complaints that cannot be reduced by medication, produces signs of nerve compression (foot drop, urinary incontinence…), and progresses, a surgical treatment is needed. The nerves in the slippage region are released by surgical treatment and the vertebrae are fixed to each other to avoid progression of slippage. The operation can be from the front or the back, or from either of the sides. The recovery process is supported by postoperative rehabilitation programs. The specialist team of physiotherapists of our hospital begins rehabilitation of patients from the first day after operation. Before discharging from the hospital, patients are taught daily activities in detail, e.g. how to get up from a bed, how to walk and go up the stairs.

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