Degenerative Spondylolisthesis (DS)

Degenerative spondylolisthesis (DS) occurs when a vertebra (bone in the spine) gradually shifts forward over the vertebra below it due to degenerative changes. This slippage often results from weakened spinal joints and discs that lose their ability to support the spine’s structure over time.

The condition is most common in the lower back (lumbar spine), but can also occur in the neck.

DS primarily affects adults over the age of 50 and is more common in women, often due to hormonal changes that occur during menopause. Long hours of sedentary work can also aggravate the condition.

At CalSpine MD, our experienced spine specialist, Dr. Hieu Ball, specializes in diagnosing and treating conditions like degenerative spondylolisthesis. He is a double fellowship-trained orthopedic surgeon with advanced training in spine surgery.

Dr. Ball takes a thoughtful, personalized approach to help you manage pain, improve mobility, and get back to living life with confidence.

Causes of Degenerative Spondylolisthesis

Degenerative spondylolisthesis is most commonly caused by age-related changes in the spine that gradually affect its stability and alignment. Several key factors can contribute to this condition.

Degenerative Disc Disease: As you age, the spinal discs, which act as shock absorbers between the vertebrae, begin to lose water content and elasticity. This condition, known as degenerative disc disease, causes the discs to shrink and become less flexible, reducing their ability to cushion the spine and maintain its structure.
Facet Joint Arthritis: The facet joints are small joints located between and behind adjacent vertebrae in the spine and help stabilize the spine. However, facet joint arthritis can lead to inflammation and stiffness of these joints. When the facet joints become weakened, they may no longer provide adequate support and can lead to instability and slippage of vertebrae.
Thickened Ligaments: Ligaments are tough bands of tissue that help hold the spine together. As the body ages, these ligaments can thicken and lose flexibility, placing additional strain on the spine and limiting its ability to move and adjust. This increased tension can further stress the spinal structure and contribute to spinal instability.

Together, degenerative changes compromise the spine’s ability to maintain proper alignment, especially during everyday activities like standing, walking, or bending. As a result, the vertebrae may begin to slip out of place, leading to the symptoms associated with degenerative spondylolisthesis.

Symptoms of Degenerative Spondylolisthesis

The symptoms of degenerative spondylolisthesis can vary depending on the degree of vertebral slippage and which spinal nerves are affected. Common symptoms include:

Lower Back Pain: This is the most common symptom. The pain often worsens with activity, especially standing, walking, or lifting, and tends to improve with rest or leaning forward slightly.
Neurogenic Claudication: This condition involves pain, numbness, tingling, or weakness in the buttocks and legs. It is usually triggered by walking or standing and is relieved by sitting or bending forward. This happens when age-related changes in the spine lead to spinal stenosis, or narrowing of the spinal canal. As the canal tightens, it can compress the spinal nerves, especially those that travel from the lower back into the buttocks and legs.
Sciatica: This refers to radiating pain that begins in the lower back and travels down one or both legs. Sciatica pain can feel like a sharp or burning sensation and may be accompanied by numbness or tingling.
Tight Hamstrings: Many patients with degenerative spondylolisthesis experience tightness or stiffness in the back of the thighs, which can affect posture and movement.
Bowel or Bladder Dysfunction: In severe cases, changes in control over bladder or bowel function may occur, requiring immediate medical attention.

Diagnosis of Degenerative Spondylolisthesis

At CalSpine MD, diagnosing degenerative spondylolisthesis begins with a thorough evaluation by Dr. Ball. He will review your medical history, assess your symptoms, and ask about your activity levels and any movements that trigger discomfort. This helps determine how the condition may be affecting your daily life.

He then performs a detailed physical examination to assess your range of motion, reflexes, muscle strength, and nerve function. He may also check for signs of sensory changes, such as tingling or numbness, as well as muscle weakness or abnormal tendon reflexes.

In order to confirm the diagnosis and better understand the extent of the spinal changes, we may perform imaging tests, such as an X-ray and MRI.

X-rays can help assess spinal alignment and show visible signs of degenerative changes. In most cases, an MRI scan is also recommended to provide detailed images of the spine’s soft tissues, including the discs, nerves, and spinal ligaments. This diagnostic process can also help identify spinal stenosis (narrowing of the spinal canal), which often occurs alongside spondylolisthesis.

Treatment Options for Degenerative Spondylolisthesis

Treatment for degenerative spondylolisthesis depends on the:

Severity of your symptoms
Degree of vertebral slippage
Presence of any neurological issues

At CalSpine MD, Dr. Ball prioritizes conservative, non-surgical treatments before considering other options. If symptoms persist or worsen over time, surgical options may be considered.

Non-Surgical Treatment

For many patients, especially those experiencing back pain without nerve-related symptoms, non-surgical treatment can be highly effective. Conservative care may include:

Activity modification to avoid movements that aggravate symptoms
Physical therapy to improve posture, mobility, and spinal strength
Core strengthening exercises to stabilize the spine
Anti-inflammatory medications (NSAIDs) to reduce pain and swelling
Epidural steroid injections to relieve inflammation and nerve compression
Bracing in some cases, to provide additional lumbar support during movement

These treatments focus on reducing pain, improving function, and preventing further spinal deterioration. Many patients respond well to this approach, especially when paired with consistent physical therapy.

However, conservative treatments may not be enough for everyone. In such cases, surgery may offer long-term relief.

Surgical Treatment

Surgical treatment may be recommended when conservative therapies fail to provide relief after 3 to 6 months, or when symptoms are severe and include nerve compression or loss of function.

Surgery is designed to relieve pressure on the spinal nerves, stabilize the spine, and reduce pain. It can be an effective option in cases with symptomatic spinal stenosis, which causes persistent, incapacitating pain and low-grade vertebral slippage.

Laminectomy

A laminectomy is a decompression surgery often used when degenerative spondylolisthesis occurs alongside spinal stenosis. It helps relieve pain and functional impairments by alleviating pressure on the spinal nerves.

Laminectomy involves creating more space within the spinal canal to ease pressure on the spinal cord or nerve roots. In some cases, if vertebral slippage is significant, the procedure may be combined with spinal fusion to enhance spinal stability.

Recovery times vary depending on the surgical approach. Patients who undergo minimally invasive lumbar laminectomy may recover within four to six weeks. However, those who have a combined laminectomy and fusion may need up to six months for complete healing.

Most patients can return to light activity within one to two months. A structured physical therapy program is usually recommended to help rebuild strength and mobility following surgery.

Spinal Fusion

Spinal fusion is the standard surgical option for treating lumbar spondylolisthesis. This procedure involves fusing two or more vertebrae together with implants and bone grafts to stabilize the spine. The goal is to reduce pain and prevent further slippage by limiting excessive movement between the affected vertebrae.

Spinal fusion is often considered for degenerative spondylolisthesis in the following cases:

There is significant spinal instability.
Pain is constant or debilitating.
Neurological symptoms, such as leg weakness or numbness, are present.

Recovery from both open and minimally invasive spinal fusion can take up to 6 months. Physical therapy strengthens the back muscles and improves spinal stability and flexibility post-surgery.

At CalSpine MD, our team will help you understand your options and guide you toward the treatment plan that best supports your goals. Whether through non-surgical methods or surgical care, we focus on helping you regain mobility and get back to the activities you enjoy pain-free.

Degenerative Spondylolisthesis Treatment in San Ramon, CA

Degenerative spondylolisthesis can significantly impact your comfort, mobility, and quality of life. However, with early diagnosis and a tailored treatment approach, you can find lasting relief.

At CalSpine MD, we offer advanced treatment options for degenerative spondylolisthesis. Dr. Ball, our board-certified spine surgeon, specializes in both innovative surgical and non-surgical techniques to manage this condition effectively.

Dr. Ball is committed to delivering individualized care that helps restore your mobility and quality of life.

For appointments, please call us at (925) 838-8830 or request an appointment online.