Telemed waiting room
Schedule an Appointment

Degenerative Spondylolisthesis

Slipped Vertebral Body

Treatment for Degenerative Spine Changes

Degenerative SpondylolisthesisSpondylolisthesis is a spinal condition in which one vertebra slips forward over the vertebra below. Degenerative spondylolisthesis usually occurs in the lumbar spine, especially at L4-L5. It results from degenerative changes in the vertebral structure, which cause the joints between vertebrae to slip forward. This type of spondylolisthesis is most common among females over age 60.

Causes of Degenerative Spondylolisthesis

Degenerative spondylolisthesis is usually the result of age and wear and tear on the spine, which breaks down vertebral components. This condition is different from isthmic spondylolisthesis since there is no bone defect. Spinal stenosis tends to occur in the early stages of degenerative spondylolisthesis.

Symptoms of Spondylolisthesis

Disc spondylolisthesis symptoms vary from patient to patient, and may include:

  • Pain, especially after exercise, in the low back, thighs and/or legs
  • Sciatica pain that radiates into the buttocks or down the legs
  • Muscle spasms
  • Leg weakness
  • Tight hamstring muscles
  • Irregular gait or limp

Some people with this condition are symptom-free and only discover the disc disorder when they see a doctor for other health concerns. In severe cases of degenerative spondylolisthesis, however, the vertebral body’s forward slip may lead to symptoms of spinal stenosis, nerve compression and neurological injury.

Diagnosing Degenerative Spondylolisthesis

Princeton Brain, Spine & Sports Medicine neurosurgeons use the latest diagnostic technologies and decades of collective expertise to diagnose your spine condition. Diagnostic tools may include:

  • Medical history. Your physician will inquire about your symptoms, their severity and the treatments you have already tried.
  • Physical examination. Our neurosurgeons will carefully examine you for movement limitations, balance problems, loss of reflexes in the extremities, pain levels, muscle weakness, loss of sensation and other signs of neurological damage.
  • Diagnostic tests. Generally, doctors start with x-rays, which allow them to rule out other problems like tumors or infections. They may also use a CT scan or MRI to confirm your spinal diagnosis. A myelogram may be used to show nerve compression, slippage between involved vertebrae and abnormal movement. This test involves an injection of liquid dye into the spinal column.

Spondylolisthesis Classification

Several methods are used to “grade” the degree of vertebral slippage, ranging from mild to most severe. Your neurosurgeon will explain the extent of your spondylolisthesis, answer your questions thoroughly and help you make an informed treatment plan with a best-case outcome. The Meyerding classification system is used to grade spondylolisthesis. Slips are graded by the percentage that one vertebral body has slipped forward over the vertebral body below.

  • Grade 1 Slip: 1 to 24%
  • Grade II: 25 to 49% slip
  • Grade III: 50 to 74% slip
  • Grade IV: 75 to 99% slip
  • Grade V (spondyloptosis): one vertebral body slips entirely off the vertebral body below.

Your PBSSM physician will consider the degree of slip and factors like intractable pain and neurological symptoms when recommending the most suitable treatment. Most degenerative spondylolisthesis cases are grade I or II. As a general guideline, the more severe slips (grades III and above) are most likely to require surgical intervention.

Treatment for Degenerative Spondylolisthesis

For most cases of degenerative spondylolisthesis (especially grades I and II), conservative treatment consists of:

  • Temporary bedrest
  • Restriction of activities that caused symptom onset
  • Pain/anti-inflammatory medications
  • Steroid-anesthetic injections
  • Physical therapy
  • Spinal bracing

Degenerative spondylolisthesis can be progressive and may cause stenosis, a narrowing of the spinal canal that compresses the spinal cord. If the stenosis is severe and non-operative treatments have failed, surgery may be necessary.

Surgical Treatment

Degenerative Spondylolisthesis Treatment Specialists NJ, PASurgery is rarely needed unless the case is severe (usually grade III or above), neurological damage has occurred, the pain is disabling or all non-operative treatment options have failed.

The most common surgical procedure used to treat spondylolisthesis is called a laminectomy and fusion. In this procedure, the spinal canal is widened by removing or trimming the laminae (roof) of the vertebrae. This is done to create more space for the nerves and relieve pressure on the spinal cord. The surgeon may also need to fuse vertebrae together. If a fusion is done, devices like screws or interbody cages may be implanted to enhance fusion and support the unstable spine.

Expert NJ & PA Treatment for Degenerative Spondylolisthesis

Most people will experience some degenerative spine changes as they age, but severe spondylolisthesis only affects a small percentage of the population. Much of the time, degenerative disorders of the spine respond to conservative, non-surgical treatment. Your doctor will work closely with you to educate you about treatment options and develop an informed, step-by-step plan for intervention. To schedule an appointment with our highly skilled physicians, call 609.921.9001 (New Jersey) or 215.741.3141 (Pennsylvania).

Request an Appointment

Submit an appointment request on our patient portal or contact our New Jersey and Pennsylvania campuses to speak with a patient advocate.

Schedule an Appointment

New Patients Existing Patients