Spondylolisthesis (Slipping Vertebra)

Spondylolisthesis means one bone in your lower spine has slipped slightly forward over the one below. It is common with age, and most people have no symptoms at all. Only a small number need surgery, and only when leg symptoms develop.

Reviewed by Dr. Kshitij Chaudhary, Last reviewed September 2026

What Is Spondylolisthesis?

Your spine is a stack of bones called vertebrae. Discs and small joints hold them in line. In spondylolisthesis, one vertebra slides forward over the one below it.

Think of a stack of books where the top book has shifted forward a little.

What Is Degenerative Spondylolisthesis?

This is the most common type. It comes with age. Over the years, the discs thin and the small joints at the back of the spine wear down. The ligaments also lose some strength. Together, these changes let one vertebra shift forward.

This page focuses on this age-related type. Other types exist. Some are present from birth. Some follow a stress fracture in the spine, often in young athletes. Some follow an injury. Each is treated a little differently.

Where Does It Happen?

Most often in the lower back. The L4–L5 level is affected most, followed by L3–L4 and L5–S1.

Who Gets It?

It is more common after the age of 50, and more common in women than in men.

How Serious Is It?

Usually, it is not serious at all. Most people with this slip have no symptoms.

If we scanned the backs of a group of healthy adults, many would show a small slip on their MRI. They have no pain and no problem. For them, nothing needs to be done.

So a slip on your report does not mean something is wrong with your spine. It matters only when it presses on the nerves and causes symptoms.

What Are the Grades?

Doctors measure the slip on a side-view X-ray. They say how much of the vertebra has moved forward:

With the age-related type, the slip is rarely beyond grade 1.

What Symptoms Can It Cause?

Most people have none. When symptoms do appear, they can include:

• Lower back pain and stiffness
• Pain in the buttock, thigh or leg
• Leg pain or heaviness when you stand or walk, which eases when you sit or bend forward
• Numbness, tingling or weakness in the legs

The leg symptoms happen when the slip narrows the space around the nerves.

How Is It Diagnosed?

• Examination: Your doctor asks about your symptoms and checks your back, legs and nerves
• X-rays: A side view shows the slip and its grade. X-rays taken while you bend forward and backward show whether the bones move
• MRI: This shows the nerves and discs, and how tight the space around them is
• CT scan: Sometimes used to see the bones in more detail

Will It Get Worse?

Unlikely. For most people, the slip stays stable. Your job, your daily activities and bending forward do not speed it up.

You do not need repeated X-rays to check whether the slip has moved. What matters is how you feel, not how the slip looks.

How Is It Treated Without Surgery?

Most people never need surgery. Treatment usually includes:

• Staying active: Short rests are fine. Long bed rest is not
• Physiotherapy: Exercises strengthen your back and core muscles, which supports your spine
• Medicines: Pain relievers and anti-inflammatory tablets can ease pain. Do not use them for more than about 10 days in a row without asking your doctor
• Injections: If leg pain is a problem, an injection near the nerve can give relief

If there are no leg symptoms, many people feel much better within about a year.

When Is Surgery Needed?

Surgery is needed only if you develop symptoms from nerve pressure, and they do not settle with non-surgical treatment. These symptoms are:

• Leg pain
• Numbness
• Weakness that develops when you stand or walk

The size of the slip is not a reason for surgery. A larger slip without these symptoms does not need an operation.

If you are unsure whether your symptoms need surgery, you can send your MRI for a second opinion before deciding.

What Does Surgery Involve?

The main aim is to free the nerves.

• Decompression: Your surgeon removes the bone and tissue that press on the nerves. This gives them room. In some situations, this can be done on its own through a minimally invasive approach, with no fusion
• Fusion: In other cases, your surgeon also joins the two vertebrae so they heal into one, held by screws and rods. This steadies the slipped level

Not everyone with a slip needs a fusion. Your surgeon will explain which operation suits you.

A fusion at one level does not usually restrict your movement in a way you will notice.

How Long Is Recovery?

After decompression alone, most people walk on the day of surgery and go home the next day. After a fusion, you usually walk within a day and stay in hospital for 2 to 3 days. Full recovery takes a few weeks to a few months. Your surgeon will give you a plan that suits you.

Can I Prevent It?

Not always, because ageing is the main cause. Staying active, keeping your back and stomach muscles strong, and staying at a healthy weight are good for your spine in general.

What Questions Should I Ask My Doctor?

• Which level is slipped, and by how much?
• Are my symptoms coming from this slip?
• Are my nerves under pressure?
• Do I need to try physiotherapy first?
• If I need surgery, do I need decompression alone, or a fusion too?
• When can I get back to walking, work and exercise?

Treatments We Offer for This

• Minimally Invasive Lumbar Laminectomy
• TLIF
• Minimally Invasive TLIF

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About Dr. Kshitij Chaudhary

This page was written by Dr. Kshitij Chaudhary, a fellowship-trained spine surgeon at P.D. Hinduja Hospital, Mumbai, trained in complex spine surgery at Harvard Medical School (Beth Israel Deaconess) and the Twin Cities Spine Center, Minneapolis. 🏃🏾About Dr. Chaudhary

This page is for general information and does not replace a medical consultation. Please see a doctor for advice about your own symptoms.