OVERVIEW

Where is the vertebral body?

The vertebral body is the individual name for each spinal bone and serves as the primary weight-bearing part of the vertebra, running longitudinally through the entire spine.

What is spondylolisthesis?

Spondylolisthesis refers to the slipping of one vertebral body relative to an adjacent vertebra, leading to mechanical or radicular pain.

Spondylolisthesis most commonly occurs in the lower lumbar spine, particularly at the L5-S1 level, but it can also occur in the cervical spine. Apart from trauma, it rarely occurs in the thoracic spine ^[1]. The direction of slippage can be anterior or posterior, though anterior slippage is more common ^[2].

SYMPTOMS

What are the symptoms of spondylolisthesis?

• Patients with lumbar spondylolisthesis typically experience lower back pain, which may be accompanied by radicular pain (linear pain or numbness extending to the lower limbs);
• Patients with cervical spondylolisthesis usually exhibit neck pain, which may be accompanied by radicular pain (linear pain or numbness extending to the upper limbs);
• Pain worsens when the body is extended, and patients often adopt a bent posture to avoid pain and nerve pressure. Over time, reduced spinal flexibility may be observed, and pressing the affected vertebrae may exacerbate the pain;
• Additionally, due to potential nerve root compression, patients may also experience symptoms such as decreased muscle strength and balance function, manifesting as walking weakness, muscle atrophy, etc. ^[4].

CAUSES

What Causes Spondylolisthesis?

Spondylolisthesis can result from various causes, including congenital, acquired, or idiopathic factors (e.g., trauma).

Primary causes include:

• Repetitive stress on the intervertebral joints;
• Reduced strength of the neural arch in youth, indicating higher fracture risk in adolescents and children;
• Trauma;
• Microtrauma from sports activities;
• Pathological causes such as tumors and connective tissue disorders;
• Iatrogenic causes, such as post-laminectomy, where greater disc elasticity in adolescents and children may increase stress on the pars interarticularis.

Spondylolisthesis may co-occur with or correlate with other conditions, including spina bifida, cerebral palsy (especially athetoid type), Scheuermann's disease, scoliosis, and rheumatoid arthritis ^[6-10].

Who Is Most Affected by Spondylolisthesis?

• Degenerative spondylolisthesis primarily affects adults. It shows strong gender and age specificity, typically emerging after age 50. Women are more commonly affected, with a prevalence of 25.0%, compared to 19.1% in men.
• Isthmic spondylolisthesis is more prevalent in adolescents and young adults but may remain asymptomatic until adulthood. Males have a higher incidence, with a prevalence of 6% to 7% before age 18. Additionally, obese patients face a higher risk ^[1,5].

DIAGNOSIS

How is spondylolisthesis diagnosed?

Spondylolisthesis is usually diagnosed through X-rays combined with clinical manifestations and symptoms (see "What are the symptoms of spondylolisthesis" above).

When should I seek medical attention for spondylolisthesis?

If symptoms persist (see "What are the symptoms of spondylolisthesis" above), recur frequently, or are severe and cannot be relieved by rest, prompt medical consultation is recommended.

Which department should I visit for spondylolisthesis?

Departments such as orthopedics, spinal surgery, pain management, or neurosurgery in hospitals. Conservative treatment and postoperative rehabilitation should be referred to rehabilitation departments or qualified rehabilitation clinics.

TREATMENT

Can spondylolisthesis heal on its own?

No.

The structural changes in spondylolisthesis are irreversible, but proper rehabilitation training can help many patients alleviate or eliminate symptoms, carry out daily activities normally without being affected by spondylolisthesis, and prevent the condition from worsening.

Can medication be taken for spondylolisthesis?

Yes. Analgesics and nonsteroidal anti-inflammatory drugs (NSAIDs) can reduce musculoskeletal pain and have anti-inflammatory effects for nerve root and joint irritation.

Can a brace be worn for spondylolisthesis?

Yes. When pain is severe, a brace can help reduce segmental spinal instability and alleviate pain ^[13]. A commonly used brace is a lumbar belt, but prolonged wear may lead to decreased activation of surrounding muscles.

Can massage be done for spondylolisthesis?

Massage therapy can be performed in a hospital's massage department, but it is not recommended to receive massage from unqualified personnel. Massage can help relieve lower back tension and increase mobility after spondylolisthesis. However, if any discomfort occurs during the massage, it is advised to communicate with the therapist immediately.

It is important to note:

• Massage is not a treatment for spondylolisthesis and cannot eliminate the condition; it can only relieve some symptoms.
• Inappropriate massage may worsen symptoms.

Are epidural steroid injections needed for spondylolisthesis?

Yes. Epidural steroid injections can be used to relieve lower back pain and lower limb pain associated with radiculopathy and neurogenic claudication ^[14].

Is surgery necessary for spondylolisthesis?

It depends. There are no clear standards, but if the doctor determines that the degree of spondylolisthesis is very severe, causing significant spinal instability, or if symptoms are intense and cannot be relieved by conservative treatment, surgery may be recommended. Additionally, about 10–15% of young patients with mild spondylolisthesis who do not respond to conservative treatment may require surgery.

Surgical methods typically include spinal decompression or fusion.

Can rehabilitation exercises be done for spondylolisthesis?

Most patients with spondylolisthesis who do not meet the criteria for surgery can improve function and control symptoms through conservative treatment.

In the early stages or when symptoms are severe, patients should avoid exercise, bending, and lifting heavy objects ^[11]. As symptoms subside, patients should gradually incorporate rehabilitation exercises focusing on improving muscle balance, not just muscle strength ^[12], but also reducing extension pressure at the lumbosacral junction and enhancing core stability.

What rehabilitation exercises can be done at home for spondylolisthesis?

Patients with mild symptoms can perform core stability-related exercises according to their ability. However, if any discomfort, ineffectiveness, or doubts arise, stop immediately and consult a doctor or therapist.

• Exercise name: Transverse abdominis activation exercise Purpose: Enhances core muscle activation, helps maintain stable intra-abdominal pressure, and improves stability in the spondylolisthesis area.
• Exercise name: Quadruped arm/leg lift core stability exercise Purpose: Improves core stability with minimal spinal pressure, reducing the likelihood of symptoms.
• Exercise name: Dead bug exercise Purpose: Increases difficulty for those with improved core stability, but not recommended for beginners.
• Exercise name: Supine sciatic/tibial nerve glide exercise Purpose: Helps patients with linear numbness in the lower limbs improve nerve mobility and alleviate symptoms.

If any discomfort occurs during home exercises, stop immediately and consult a professional to prevent worsening the condition.

What exercises can be done with the help of a doctor or therapist for spondylolisthesis?

During rehabilitation, a doctor or therapist will tailor exercises based on the patient's condition and ability, including core stability, flexibility, muscle strength, coordination, balance, and cardiopulmonary function training.

DIET & LIFESTYLE

Does Spondylolisthesis Require Rest?

It depends.

• When symptoms first appear or are severe, patients are advised to rest to help alleviate pain, reduce inflammation, and take or receive medication as needed.
• When symptoms subside or do not significantly affect activity, patients should gradually resume normal daily activities to prevent further decline in physical function and avoid subsequent issues.

Can People with Spondylolisthesis Exercise?

Yes, but the type of exercise should be chosen carefully.

• The most recommended exercises are those that promote core stability.
• Patients can also engage in low-to-moderate-intensity aerobic exercises, such as walking or freestyle swimming, which can help reduce chronic lower back pain and disability while improving cardiovascular function ^[12][15].

What Exercises Should Be Avoided with Spondylolisthesis?

Patients are advised to avoid exercises involving repetitive lumbar flexion and extension, such as gymnastics, breaststroke, running, heavy weightlifting, sit-ups, and "superman" exercises.

What Should Spondylolisthesis Patients Pay Attention to in Daily Life?

1. Maintain Proper Sitting Posture
   Avoid prolonged sitting. When sitting for long periods (e.g., for work or study), maintain good posture with proper lumbar support and sit fully back in the chair. The chair height should allow the hips, knees, and ankles to form a 90-degree angle, with the neck in a neutral position. Desks and computer screens should be at eye level, and elbows and hands should be naturally relaxed and supported.

2. Maintain Proper Standing Posture
   Avoid prolonged standing. When standing for long periods, keep the posture upright: squeeze the glutes, slightly engage the core, lift the chest slightly, and tuck the chin slightly to avoid excessive neck or lumbar extension or flexion.

3. Lifting Objects (Especially Heavy Ones)

   • Patients with spondylolisthesis should avoid lifting heavy objects or excessive bending.
   • When lifting objects from the ground, get as close as possible to the object, squat down, stabilize the core to avoid bending, and use leg strength to lift.
   • When lifting and turning (e.g., picking up a child from a crib), rotate the entire body using the legs rather than twisting the lower back uncontrollably.

4. Avoid rapid or forceful neck extension, head tilting, or rotational movements, as well as overstretching or sneezing forcefully.
   If spondylolisthesis symptoms are already present, these actions may increase pressure on the affected area and worsen symptoms.

5. Sleeping Posture

   • Lying down generally relieves symptoms. For back sleepers, placing a pillow under the knees can help; side sleepers can place a pillow between the legs. Stomach sleeping is generally not recommended.
   • For cervical spondylolisthesis, back sleepers should use a pillow that supports the neck in a neutral position, while side sleepers need a pillow high enough to keep the head level with the body.

PREVENTION

Can Spondylolisthesis Be Prevented?

Yes, it can. In addition to maintaining good sitting and standing postures in daily life, the following strategies can also help prevent spondylolisthesis.

1. Changing Positions Frequently
   Whether standing or sitting, maintaining the same posture for too long is not good for health. Therefore, every 45–60 minutes, take 10–15 minutes to switch between sitting and standing, or engage in activities such as walking, stretching, going to the bathroom, or getting a glass of water. These actions can help relieve fatigue and prevent injuries.

2. Using a Standing Desk
   If possible, those who work long hours at a desk are advised to use a standing desk. Switching between sitting and standing every 45–60 minutes can prevent injuries without disrupting work progress.

3. Exercising More

   • Engage in regular physical activity and develop good exercise habits to avoid prolonged sitting.
   • Aim for at least 3 sessions per week of moderate-intensity exercise lasting 30 minutes or more, or accumulate 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity physical activity weekly. Exercise choices can be based on ability, age, and preferences, such as aerobic activities (running, brisk walking, swimming, etc.), comprehensive exercises (dancing, aerobics, tai chi, etc.), or ball sports (badminton, basketball, etc.).
   • Stay active in daily life, aiming for 6,000–10,000 steps per day ^[16,17].