Lumbar Spondylolisthesis vs Spondylosis

This article will explain the two conditions of the spine, spondylolisthesis vs spondylosis, and their causes and symptoms, before starting to discuss the topic. Let's learn about these conditions. Lumbar spondylolisthesis refers to a condition where one vertebra slips forward over the vertebra below it. This can occur due to a variety of factors, including congenital abnormalities, degenerative changes in the spine, or traumatic injury. Symptoms of lumbar spondylolisthesis can include lower back pain, stiffness, muscle weakness, and nerve compression leading to radiating leg pain or numbness.

On the other hand, spondylosis refers to a degenerative condition that affects the spinal discs and joints. It is commonly associated with aging and wear and tear on the spine. Spondylosis typically involves the breakdown of the intervertebral discs and the development of bone spurs, causing the narrowing of the spinal canal and compression of the nerves. Symptoms of spondylosis can include chronic back pain, stiffness, reduced flexibility, and radiating pain or numbness in the legs.

Lumbar spondylosis vs spondylolisthesis symptoms

Lumbar spondylosis and spondylolisthesis are two distinct conditions that affect the lower back or lumbar spine. While they share some similarities, they have different underlying causes and can present with varying symptoms.

Lumbar spondylosis is a degenerative condition that primarily affects the intervertebral discs and joints in the spine. Common symptoms of spondylosis include chronic lower back pain, stiffness, reduced flexibility, and muscle spasms. In some cases, spondylosis can lead to the narrowing of the spinal canal (spinal stenosis), causing compression of the nerves and resulting in radiating pain or numbness in the legs.

Spondylolisthesis, on the other hand, involves the forward slippage of one vertebra over the one below it. Symptoms of lumbar spondylolisthesis can include lower back pain, especially after physical activity, stiffness, muscle weakness, and a sensation of instability in the spine. Depending on the severity of the slippage, spondylolisthesis can also cause nerve compression, leading to symptoms such as radiating leg pain, numbness, or tingling.

It's important to note that symptoms can vary greatly depending on the individual and the specific characteristics of the condition. Some people may experience mild discomfort, while others may have more pronounced symptoms that significantly affect their daily activities.

Stages of Lumbar Spondylolisthesis

The condition is often graded into different stages based on the severity of the slippage. The most commonly used grading system is the Meyerding classification, which divides spondylolisthesis into four stages:

1. Grade I (Mild): In grade I spondylolisthesis, the forward slippage is minimal, up to 25% of the vertebral body's width. The vertebra has shifted slightly forward over the one below it, but the displacement is relatively small.

2. Grade II (Moderate): Grade II spondylolisthesis indicates a slippage of 26% to 50% of the vertebral body's width. The forward displacement is more noticeable in this stage, but the vertebrae are still aligned reasonably well.

3. Grade III (Severe): In grade III spondylolisthesis, the forward slippage is between 51% and 75% of the vertebral body's width. The vertebrae are significantly misaligned at this stage, which can lead to more pronounced symptoms and potentially affect nerve structures in the spinal canal.

4. Grade IV (Very Severe): Grade IV spondylolisthesis involves slippage of 76% to 100% of the vertebral body's width. This is a severe condition, with the affected vertebra significantly displaced forward over the one below it, causing considerable spinal instability and potential nerve compression.

Apart from the Meyerding classification, there is also a Grade V spondylolisthesis, also known as spondyloptosis. This is an extremely rare and severe condition where the affected vertebra completely slips off the one below it and moves forward completely out of alignment.

What Makes Spondylolisthesis Worse?

Several factors can contribute to the worsening of spondylolisthesis, a condition characterized by the forward slippage of one vertebra over another. Here are some factors that can potentially worsen spondylolisthesis:

1. Physical activity: Engaging in high-impact or strenuous activities that place excessive stress on the spine can exacerbate spondylolisthesis. Activities like heavy lifting, repetitive bending, or twisting motions can increase the risk of further slippage or injury.

2. Poor posture: Maintaining poor posture, especially over a prolonged period, can strain the spinal structures and potentially worsen spondylolisthesis. Slouching, sitting or standing for extended periods without proper support, and incorrect lifting techniques can all contribute to increased stress on the affected vertebrae.

3. Obesity: Carrying excess weight places additional strain on the spine, which can accelerate the progression of spondylolisthesis. The added load increases the stress on the vertebrae and can worsen the instability and slippage.

4. Traumatic injury: Spondylolisthesis can be caused or aggravated by traumatic incidents such as falls, accidents, or sports-related injuries. Sudden impact or trauma to the spine can disrupt the stability of the affected vertebrae and lead to further slippage.

5. Aging and degeneration: As the spine naturally undergoes age-related wear and tear, the intervertebral discs may degenerate, resulting in decreased disc height and stability. This degeneration can contribute to the progression of spondylolisthesis.

Physiotherapy Treatment for Lumbar Spondylolisthesis

Lumbar spondylolisthesis is a condition where one vertebra slips forward in relation to the vertebra below it in the lower back. Physiotherapy can play an important role in the treatment of lumbar spondylolisthesis by addressing pain, improving mobility, and strengthening the surrounding muscles. Here are some common physiotherapy treatments that may be used for lumbar spondylolisthesis:

MRI shows L4 slipped over the L5 vertebra

Pain Management Techniques: Physiotherapists can employ various pain management techniques, such as moist heat in the lumbar region for 25-30 min so that muscles will relax and the pain subside. Electrical Stimulation or TENS (transcutaneous electrical nerve stimulation: Continuous mode at least 20 min) can be beneficial for relieving radicular pain. These modalities can help reduce pain and inflammation in the affected area.

Manual Therapy: This involves hands-on techniques performed by a physiotherapist to mobilize (Mobilize the spinal segments above and below the slipped vertebra and sacroiliac joint as well) and manipulate the spine, pelvis, and surrounding joints. Manual therapy can help relieve pain, improve joint mobility, and restore proper alignment.

Postural Education and Training: Poor posture can contribute to the progression of spondylolisthesis and exacerbate symptoms. Physiotherapists can educate patients about proper posture and body mechanics to minimize stress on the spine during daily activities. They may also provide guidance on ergonomics, such as appropriate sitting positions and lifting techniques.

Education and Lifestyle Modification: Physiotherapists can educate patients about their condition, its causes, and ways to manage symptoms. They may also provide guidance on modifying activities that may aggravate the condition and recommend lifestyle changes to promote spinal health.

Spondylolisthesis exercises (Therapeutic Exercises) 

Specific exercises are prescribed to strengthen the muscles in the lower back, abdomen, and hips. Strengthening these muscles can provide better support to the spine and help stabilize the affected area. Examples of exercises may include core strengthening exercises, gentle stretching, and postural exercises. Here are some very important exercises which alleviate your pain:

1. Piriformis stretching

2. Knee to Chest Exercise

3. 90-90 position

Piriformis stretching 

Piriformis stretching can be beneficial for individuals with lumbar spondylolisthesis, as it can help alleviate symptoms and improve mobility. The piriformis muscle is located in the buttock region and plays a role in stabilizing the pelvis and facilitating hip movement. When the piriformis muscle is tight or inflamed, it can contribute to lower back pain and worsen the symptoms of spondylolisthesis. Stretching this muscle can help reduce tension and alleviate discomfort. 

Here are some potential effects of piriformis stretching in lumbar spondylolisthesis:

1. Alleviating Muscle Tension: Stretching the piriformis muscle can help release tension and reduce muscle tightness. This can help relieve pain and discomfort in the lower back, buttocks, and legs that may be associated with spondylolisthesis.

2. Improving Hip Mobility: Tightness in the piriformis muscle can restrict hip mobility, leading to difficulties in walking, bending, or performing daily activities. Regular stretching can help improve the flexibility of the piriformis muscle and enhance the hip range of motion, making movements easier and more comfortable.

3. Reducing Nerve Compression: In some cases of spondylolisthesis, the slipped vertebra can put pressure on the sciatic nerve, resulting in sciatic symptoms such as leg pain, numbness, or tingling. The piriformis muscle passes over the sciatic nerve, and when it is tight, it can compress the nerve further. Stretching the piriformis muscle can help relieve this compression, reducing sciatic nerve symptoms.

4. Enhancing Postural Alignment: Lumbar spondylolisthesis can affect spinal alignment and posture. Tightness in the piriformis muscle can contribute to a forward tilt of the pelvis, which can exacerbate the condition. Stretching the piriformis muscle can help restore proper alignment and promote better posture, reducing stress on the lumbar spine.

Knee-to-chest exercise

Knee-to-chest exercise can be beneficial for individuals with lumbar spondylolisthesis as it helps stretch and mobilize the lower back and hip muscles, potentially reducing pain and improving flexibility. Here are some potential effects of the knee to chest exercise in lumbar spondylolisthesis:

1. Stretching the Lower Back: The knee-to-chest exercise involves bringing one knee toward the chest while keeping the other leg extended. This movement helps stretch the muscles and soft tissues of the lower back, including the spinal erectors. Stretching these muscles can alleviate tension and promote relaxation in the area, potentially reducing pain and discomfort.

2. Mobilizing the Lumbar Spine: The knee-to-chest exercise involves flexion of the lumbar spine as you bring your knee toward your chest. This movement helps mobilize the lumbar vertebrae, which can improve joint mobility and reduce stiffness. Increasing the mobility of the lumbar spine can also help restore normal movement patterns and reduce the risk of further complications.

3. Relieving Nerve Compression: In some cases of lumbar spondylolisthesis, the slipped vertebra can compress the nerves exiting the spinal column, leading to symptoms such as leg pain, numbness, or tingling. The knee-to-chest exercise can help relieve this compression by gently stretching the affected area, potentially reducing nerve-related symptoms.

4. Promoting Flexibility of Hip Muscles: The knee-to-chest exercise also stretches the hip muscles, including the glutes, hip flexors, and piriformis. Tightness in these muscles can contribute to lower back pain and worsen symptoms of spondylolisthesis. By stretching and improving the flexibility of these muscles, knee-to-chest exercise can help alleviate pain and enhance overall hip function.

Hip-knee 90-90 exercise

The hip-knee 90-90 exercise can have positive effects on individuals with lumbar spondylolisthesis. Here are some potential effects of the hip-knee 90-90 exercise in lumbar spondylolisthesis:

1. Relieving Lumbar Spine Pressure: The hip-knee 90-90 exercise helps to create a neutral spine position and alleviates pressure on the lumbar vertebrae. By maintaining proper alignment during the exercise, you can reduce stress on the affected area and potentially reduce pain and discomfort associated with lumbar spondylolisthesis.

2. Enhancing Posture and Core Stability: Proper posture and core stability are important for individuals with lumbar spondylolisthesis. The hip-knee 90-90 exercise engages the core muscles to maintain a stable position during the stretch. Regular practice of this exercise can help strengthen the core, improve posture, and provide better support to the lower back.

Author note

This article is for educational purposes only. Don't try any exercise or treatment protocol at your home if you have any back issues. Please consult a skilled and registered physiotherapist before starting any exercise for the same.

Read more

1. Immediate Relief for Sciatica Pain
2. What is the home remedy for knee pain?
3. What is Manual Spinal Traction in Physiotherapy?
4. Lumbar Spondylolisthesis vs Spondylosis
5. How Can Poor Posture Result in Back Pain: 7 Consequences
6. Cervical Radiculopathy Physical Therapy Techniques

People also ask

What is the difference between spondylolisthesis and spondylosis?

Spondylolisthesis and spondylosis are two distinct spinal conditions that affect different parts of the spine. Spondylolisthesis is a condition where one vertebra slips forward over the vertebra below it. This misalignment can cause pressure on nerves, leading to pain, weakness, and tingling sensations. Spondylolisthesis is commonly caused by degenerative changes, congenital abnormalities, or repetitive stress on the spine. On the other hand, spondylosis refers to general wear and tear of the spine due to aging, affecting the intervertebral discs, joints, and ligaments. It is a natural part of the aging process and can lead to the formation of bone spurs (osteophytes) and a decrease in disc height. While spondylosis is usually a normal age-related condition, it can also contribute to the development of spondylolisthesis.

What's the difference between spondylosis and spondylolysis?

Spondylosis and spondylolysis are two distinct spinal conditions that affect different structures of the spine. Spondylosis refers to age-related degenerative changes that occur in the spine over time. It involves the wear and tear of the intervertebral discs, facet joints, and ligaments, leading to conditions such as disc degeneration and the formation of bone spurs (osteophytes). Spondylosis is a common part of the aging process and can cause symptoms like stiffness, reduced mobility, and localized pain in the affected area. On the other hand, spondylolysis is a specific condition that involves a defect or fracture in the pars interarticularis, a small bony segment connecting the upper and lower facets of a vertebra. Spondylolysis can be a result of repetitive stress or a congenital condition. If left untreated, it may progress to spondylolisthesis, where one vertebra slips forward over another, potentially causing nerve compression and more severe symptoms.

What are the 5 stages of spondylolisthesis?

Spondylolisthesis is graded into five stages based on the degree of vertebral slippage (forward displacement) relative to the vertebra below it. The grading system used is called the Meyerding Classification. The five stages are as follows: 1. Grade 1: This is the mildest stage, where the forward slippage is less than 25% of the width of the vertebra below it. 2. Grade 2: In this stage, the slippage is between 25% to 49% of the width of the lower vertebra. 3. Grade 3: The slippage progresses to 50% to 74% of the width of the lower vertebra. 4. Grade 4: At this stage, the slippage is severe, with 75% to 99% of the width of the lower vertebra involved. 5. Grade 5: This is the most severe stage, where the vertebra completely slips off the vertebra below it, known as spondyloptosis. The severity of the condition is essential for determining the appropriate treatment, as more extensive slippage can lead to nerve compression and more significant symptoms. Medical professionals use imaging tests, such as X-rays or MRI, to diagnose and classify the stage of spondylolisthesis.

What is the best treatment for spondylolisthesis?

The best treatment for spondylolisthesis depends on the severity of the condition and the individual's symptoms. Non-surgical approaches, such as rest, physical therapy, and pain management, are typically the first line of treatment for mild cases. Strengthening core muscles can help stabilize the spine. In more severe cases, where neurological symptoms or significant slippage are present, surgery may be recommended to decompress nerves and stabilize the spine. Surgical options include spinal fusion or laminectomy with instrumentation. The choice of treatment should be made in consultation with a qualified healthcare professional to tailor it to the patient's specific needs and condition.

How can spondylolisthesis be cured?

Spondylolisthesis cannot be "cured" traditionally, as it involves the structural displacement of vertebrae. However, it can be effectively managed to alleviate symptoms and improve quality of life. Non-surgical treatments like rest, physical therapy, pain management, and targeted exercises can help stabilize the spine and reduce discomfort in mild cases. In more severe instances, surgical intervention may be necessary to decompress nerves and stabilize the spine through procedures like spinal fusion. Regular exercise, proper body mechanics, and maintaining a healthy weight are also essential for long-term management. Treatment should be tailored to each individual's condition and needs.

Is walking good for spondylolisthesis?

Yes, walking can be beneficial for individuals with spondylolisthesis, especially in mild to moderate cases. Walking is a low-impact aerobic exercise that helps strengthen muscles, including those that support the spine. It can improve flexibility, promote blood flow, and enhance overall spine health. However, it is essential to approach walking with caution and follow specific guidelines: 1. Start gradually: Begin with short walks and gradually increase the duration and intensity to avoid overexertion. 2. Maintain good posture: Keep your back straight and shoulders relaxed while walking to reduce strain on the spine. 3. Choose supportive footwear: Wear comfortable and supportive shoes to provide adequate cushioning for your feet and spine. 4. Listen to your body: If walking exacerbates pain or discomfort, consult a healthcare professional for advice on modifying your exercise routine. Always consult with a healthcare provider before starting any exercise program, especially if you have spondylolisthesis, to ensure it is safe and appropriate for your specific condition.

Is spondylolisthesis life long?

Yes, spondylolisthesis is typically considered a lifelong condition. It is a structural abnormality in which one vertebra slips forward over the one below it, and this misalignment does not resolve on its own without medical intervention. While the condition can be managed and symptoms can be alleviated through various treatments such as physical therapy, pain management, and in some cases, surgery, the underlying structural issue remains. With appropriate management and lifestyle adjustments, individuals with spondylolisthesis can lead active and fulfilling lives. It is essential to work with healthcare professionals to develop a personalized treatment plan and follow their guidance to manage the condition effectively and minimize symptoms in the long term.

Can exercise cure spondylolisthesis?

Exercise alone cannot cure spondylolisthesis because it is a structural abnormality where one vertebra slips forward over another. However, exercise can be a crucial component of managing spondylolisthesis and improving the symptoms associated with the condition. Targeted exercises, under the guidance of a qualified healthcare professional or physical therapist, can help strengthen the core muscles, stabilize the spine, and improve flexibility. Stronger muscles can provide better support to the affected area and reduce strain on the spine, potentially alleviating pain and discomfort. While exercise can be beneficial, it is essential to recognize that spondylolisthesis is a structural issue that cannot be reversed solely through physical activity. A comprehensive approach, including exercises, pain management, and other treatments, may be necessary to effectively manage the condition and improve the individual's quality of life.