What is Lumbar Spondylolisthesis?
Lumbar spondylolisthesis, medically known as spondylolisthesis, occurs when one vertebra slips forward over the vertebra below it. This condition disrupts the alignment and integrity of the spine as a whole. Its prevalence in the general population is approximately 3-5%.

What Causes Lumbar Spondylolisthesis?
The spine has three main functions: to bear and transmit the body’s weight, enable mobility, and protect the spinal cord.

Maintaining movement within physiological limits and preserving both range and flexibility of motion are crucial for spinal stability. Structures that help keep the spine stable under excessive load include muscles and tendons, vertebrae, facet joints, discs, and the neural system. All of these work in coordination to absorb and distribute the forces acting on the spine.

The exact cause of lumbar spondylolisthesis is not fully known, but several factors may contribute:

• Trauma: This can be blunt, minor, or micro-trauma. The risk of spondylolisthesis is higher in young adults who engage in sports, especially if the sport involves repetitive lumbar movements. For example, the incidence among athletes in gymnastics can reach approximately 7-10%, nearly double the general population rate.
• Congenital spinal development abnormalities.
• Genetic factors: Evidence shows a strong familial link. The incidence of spondylolisthesis in first and second-degree relatives of affected individuals is 25-30% higher. Some ethnic groups also have a higher prevalence, supporting the genetic role—for instance, Eskimos have rates as high as 40%.
• Bone degeneration: This usually occurs after age 50 and is five times more common in women. Osteoporosis is often responsible. Degenerative changes often coexist with spinal canal narrowing.
• Metastatic diseases such as cancer and certain blood disorders: Spread of disease to bones can alter bone structure and increase the risk of vertebral slippage.

What are the Symptoms of Lumbar Spondylolisthesis?
Symptoms vary depending on the cause and the patient’s age. Spondylolisthesis is graded based on the amount of vertebral slippage, from grade one to four. Low-grade spondylolisthesis often remains asymptomatic and stable without progression, frequently discovered incidentally or presenting later with back pain in adulthood.

Regardless of cause or type, pain is the most common complaint bringing patients to the doctor. The pain usually worsens in certain positions and improves in others. It typically increases with bending forward and decreases when bending backward.

Pain is usually localized to the lower back and hip area. It worsens with heavy lifting, prolonged walking, or standing and eases with rest.

If spondylolisthesis is accompanied by spinal canal narrowing and/or nerve root compression, the pain pattern changes. In such cases, pain radiates to the leg, thigh, and foot and may be accompanied by numbness and weakness.

How is Lumbar Spondylolisthesis Diagnosed?
Lumbar spondylolisthesis often progresses without symptoms. The most important complaint is usually pain, which prompts patients to visit a physical therapy and rehabilitation specialist. A detailed history and thorough physical exam combined with radiological tests typically confirm the diagnosis.

Lateral (side view) plain X-rays are diagnostic for this condition. Advanced imaging techniques such as CT, MRI, SPECT, and bone scintigraphy are also useful for monitoring and treatment planning.

How is Lumbar Spondylolisthesis Treated?
Improper or rough interventions to the spine can lead to poor outcomes. The initial treatment approach should be conservative (non-surgical supportive therapy), as most patients respond well and show significant improvement.

Generally, treatment includes:

• Avoiding certain sports and limiting activities as needed.
• Using NSAIDs (non-steroidal anti-inflammatory drugs) when pain occurs.
• Wearing an antilordotic rigid lumbar brace for at least 3-6 months.
• Undergoing physical therapy, which is essential in conservative treatment.

The lumbar brace used should be antilordotic and worn for 3 to 6 months. Patients should avoid sudden movements and lifting heavy loads, as well as excessive forward or backward bending of the spine.

Physical therapy often produces very positive results. Exercises should focus on strengthening the muscles of the lower back, hips, upper back, and abdomen. Patients are encouraged to engage in activities that protect spinal flexion, such as swimming, walking, and cycling, while avoiding high-impact activities like running that increase load on the spine.

Each patient must be evaluated individually to create a tailored rehabilitation program. The goal of physical therapy and exercise is to strengthen and stabilize the slipped vertebra.

If symptoms do not improve despite physical therapy and rehabilitation, or if there are clear signs of nerve compression, surgical consultation is warranted.