Spinal Series 4

Spondylolisthesis

What is Spondylolisthesis?

Spondylolisthesis (pronounced: Spon-di-lo-lies-thesis) is the medical term given to anterior (forward) slipping of one vertebra above the one below. Although this can occur throughout the spine, it is most common within the lumbar vertebrae and more specifically at L5 slipping forward on the sacrum (S1).

A Spondylolisthesis is usually preceeded by a Spondylolysis (pronounced: Spon-di-lo-lie-sis) which refers to a fracture of the pars interarticularis (or Pars for short). The pars interarticularis is a thin slice of bone on the vertebra located in between the inferior and superior articular processes of the facet joint.


There are three main types of Spondylolisthesis:

1.    Acquired Spondylolisthesis
2.    Developmental Spondylolisthesis
3.    Congenital Spondylolisthesis

Congenital Spondylolisthesis is essentially where someone is born with a Spondylolisthesis. Developmental Spondylolisthesis defines someone who has a Pars interarticularis that has not fused properly during early development and leads to a Spondylolisthesis. In both cases, the individual may never experience symptoms of a Spondylolisthesis unless the spine is loaded or stressed inadequately as in an Acquired Spondylolisthesis.

Acquired Spondylolisthesis defines the most common type of Spondylolisthesis including stresses to the spine during activity, exercise, sport and / or trauma. For the purpose of this article, Acquired Spondylolisthesis will be addressed in more depth.

* Note that irrespective of the type of Spondylolisthesis, the management would remain the same.

What causes Spondylolisthesis?

There are several factors that can cause a Spondylolisthesis including:

•    Force or stress to the spine associated with activity
•    Increased loading on the spine from a growth spurt
•    Trauma
•    Overuse
•    Infection or disease

The most common cause of a Spondylolisthesis is a combination of a growing adolescent partaking in regular sport. In this population, it is often the weaker, developing pars interarticularis that is excessively loaded during high impact sporting activity (gymnastics, football, athletics, etc.) leading to a spondylolysis and eventually a spondylolisthesis. Sports that increase stress to the spine through extension movement patterns are at greater risk of causing this injury.

The second most common cause of a Spondylolisthesis is spinal degeneration. Degenerative changes to the facet joints lead to a change in their orientation on each other, an increase in the laxity of the facet capsule and weakening of the surrounding stabilising ligaments. This changes coupled with an increased lumbar lordosis in the elderly population can cause a spondylolisthesis and further lead to spinal stenosis. In severe cases, surgery may be the only option.

What are the symptoms of Spondylolisthesis?

The main symptoms of a Spondylolisthesis are:

•    Low back pain / constant ache with prolonged standing
•    Referred pain into the legs
•    Referred pain into the buttocks
•    Muscular stiffness, particularly the hamstring group
•    Increased lumbar lordosis

Levels / Grading of Spondylolisthesis

The grading scale of choice for Spondylolisthesis is the ‘Meyerding’ system which quantifies severity of the forward slip through analysis of a lateral X-ray. The percentage of the superior vertebra that has slipped forward on the inferior vertebra determines the grade of Spondylolisthesis.

Grade 1:    0 – 25%
Grade 2:    25 – 50%
Grade 3:     50 – 75%
Grade 4:    75 – 100%

As a Pilates teacher you are unlikely to work with a client with a Grade 3 / 4 Spondylolisthesis as their symptoms are usually too severe to respond well to conservative management. In these cases, a spinal fusion is often required to stabilise the spine prior to beginning any conservative rehabilitation.

Conservative management of Spondylolisthesis and Pilates

Clients suffering with a grade 1 / 2 Spondylolisthesis are perfect for Pilates. The majority of these cases respond really well to conservative management including the strengthening of their deep spinal and pelvic stabilisers, abdominals and mid thoracic postural stabilisers.

Education on segmental movement can empower the client to have a better understanding of their areas of weakness whilst also re-training their stabilisers to support the vertebral column and reduce the occurrence of spinal stenosis.

Extension movement patterns are best avoided in the early stages to allow any inflammation / irritation of the pars interarticularis to heal. Once their symptoms are under control, extension can be introduced gradually as part of a complete spinal movement programme.

As with all lumbar spine pathology, don’t neglect the importance of strengthening and increasing the client’s awareness of their upper body. Working the entire spine will achieve results quicker and further aid in the prevention of any reoccurrence of their symptoms.