Your spine is one of the most important and complex parts of your body - keeping it healthy is vital if you want to lead an active and pain free life.
When the spinal bones move out of their proper alignment and one vertebra slips forward or backward onto another vertebra below.
The slip usually occurs between the fifth bone in the lower back and the first bone in the sacrum (pelvis) area but can be sometime be between the fourth and fifth lumbar vertebrae.
It is categorized into five grades of severity according to the degree of slip.
Birth defect of weakness in that area of the spine
Traumatic fractures from sudden injury
Stress fractures - These are common in teenage athletes (especially gymnasts, weight lifters and footballers) due to stress on bones in the lower back caused by repeatedly overstretching the spine.
Degenerative disease (such as arthritis)
The severity and type of symptoms depend on the grade of the condition but can include:
General pain across the lower back (that may feel like muscle strain)
Tenderness in the affected area
Muscles spasms and stiffness, especially tightness in the hamstrings
Pain that radiates down into the buttocks and legs
Change in gait and posture
Numbness, tingling, weakness and sciatica (from pressure on nerve roots)
The condition can produce increased lordosis (also called a swayback posture, where the lower back over-arches), or kyphosis (roundback) as the upper spine falls off the lower spine.
A physical examination - raising a straight leg may be uncomfortable or painful, for example an X-ray will show if a vertebra is out of place and if there are any fractures
A CT scan or MRI scan may be needed before treatment if the nerves are affected
This varies depending on the severity of the condition but initial treatment is usually conservative.
Anti-inflammatory medicines to reduce back pain
Wearing a stiff back brace
Physical therapy strengthening and stretching exercises
Modifying activity - e.g. avoiding overstretching the back and playing contact sports until symptoms go away (in most cases, you can resume activities slowly)
Conservative therapy for mild spondylolisthesis is successful in about 80% of cases.
If pain does not get better with conservative treatment, the slip is severe or there are any neurological changes, then an operation may be needed.
This procedure is performed between the lumbar vertebra and the sacrum. Sometimes, an internal brace of screws and rods is also used to hold together the vertebra as the fusion heals.
Surgery leads to satisfactory results in 85-90% of people with severe, painful spondylolisthesis.
"My heartfelt thanks go out to Mr Rai for his care and expertise, without which I would not be enjoying life as I do now."
Read case studies >
Mr M, aged 66
Treatment: Spinal decompression with instrumentation
The patient's experience
"I developed a severe pain in by back and left leg. The pain became so great that I was forced to give up playing golf and bowls. I could barely walk 100 yards and was considering other methods of mobility. An x-ray on my lower spine identified the problem as spodylolisthesis.
During my consultation, Mr Rai clearly explained to me what needed to be done to correct the problem and answered all my questions.
Much to my amazement there was no pain after the operation and within weeks, following physiotherapy to help strengthen my muscles, I was already getting back into a normal routine.
One year on, I'm playing a full round of golf, back on the bowling green and walking several miles without discomfort.
My heartfelt thanks go out to Mr Rai for his care and expertise, without which I would not be enjoying life as I do now."