Spondylolisthesis in the lower back commonly occurs between the L3-L4 and L4-L5 vertebrae. It happens when a vertebra slips forward over the one below it, weakening the structural integrity of the spine. This condition is a common cause of sciatica, where the sciatic nerve becomes compressed, causing pain and other symptoms. Treatment begins conservatively with medications, physical therapy, and injections. Surgery to fuse the vertebrae is only considered if conservative treatments fail to relieve severe, debilitating pain over several months.

1. Spondylolisthesis in the
Lower Back

2. Spondylolisthesis in the lower back (lumbar spine) commonly occurs at
the L3-L4 (third and fourth lumbar vertebrae) and L4-L5 (fourth and
fifth lumbar vertebrae) levels.
Made up of five total vertebrae in most people, the lumbar spine is
especially susceptible to this condition because it supports nearly half
of the body’s weight and is the most flexible region of the spine;
therefore, it degenerates more quickly than the less-stressed neck,
upper back, or middle back. To fully understand how vertebral slippage
affects the lower back, it’s helpful to review the basics of spinal
anatomy.

3. Spinal Anatomy
Vertebrae are the bony building blocks that form the spine. Most vertebrae are connected together at
points called facet joints, which help give the spine a wide range of motion. Sandwiched between these
vertebrae are intervertebral discs, the spongy pads that act as shock absorbers for the spine.
These spinal components – along with ligaments and
muscles – are tasked with properly supporting the body
and facilitating movement.
Over time, the intervertebral discs and facet joints in the lower
back weaken and are less able to maintain the structural integrity
of the spinal column, making it possible for a vertebra to slip
forward and over the vertebra beneath it.

4. Sciatica Caused by Spondylolisthesis
Spondylolisthesis in the lower back is a common cause of sciatica, which is a term used to describe a group of
symptoms that occur when the sciatic nerve becomes compressed by an anatomical abnormality. The sciatic
nerve is the longest and largest nerve in the body, starting in the lower back and branching off into the
buttocks, legs, and feet. If the vertebra slips forward far enough, it may press on the sciatic nerve or one of its
nerve roots, causing symptoms of:
• Pain
• A burning sensation
• Tingling
• Numbness
• Muscle weakness
• Cramping or spasms
These symptoms may stay localized at the site of vertebral slippage, though it is more likely that they will travel
throughout your lower back, buttocks, hips, legs, and feet. Severe spondylolisthesis in the back may cause
changes in posture or gait.

5. Treatment for Lumbar
Spondylolisthesis
Treatment for spondylolisthesis in the lower back will begin
conservatively, most likely with over-the-counter, non-steroidal anti-
inflammatory drugs, heat therapy, ice compresses, behavior
modification, and gentle stretching. Physical therapy, epidural steroid
injections, prescription medication, and endoscopic procedures may
also become options. The aim of these treatments is not to force the
vertebra back into place, but rather to relieve the symptoms that are
caused by nerve compression.

6. Is Surgery Necessary?
Realignment of the vertebrae in the form of surgery will only become an option in rare cases,
where the pain of vertebral slippage is severe, debilitating, and unresponsive to several months
of non-invasive treatment. In these cases, spinal fusion may be required. This surgery involves
realigning the slipped vertebra with adjacent vertebrae and fusing them together with bone
grafts, rods, and screws. While spinal fusion can put a slipped vertebrae back into place and
relieve pressure placed on the spinal cord or nerve roots, the fused segment will no longer be
able to move. The fused vertebrae may cause the spinal components in other levels of the spine
to work harder, which can accelerate degenerative changes and cause additional problems. For
these reasons, it’s important for patients to fully understand all of the risks and benefits
associated with spinal fusion or any other procedure before consenting to it.