Of the many musculoskeletal conditions we treat, spondylolisthesis is a common one. After more than two decades of practice in Irvine and Orange County, I’ve treated many cases. If you’re here, chances are you—or someone you know—has been diagnosed with spondylolisthesis or suspects it.
You’re in the right place. In this blog, we’ll cover:
- What spondylolisthesis means
- What causes it
- How it’s diagnosed
- Treatment options
- The difference between spondylolisthesis and spondylolysis
- When surgery is necessary
- The role of posture
- The connection between spondylolisthesis and the pelvic floor
We’ll even clear up a common question: does it affect the spine or spinal cord? And yes—we’ll finally settle how to pronounce it. Let’s dive in.
What Spondylolisthesis Means
Say it with me: spon-dee-low-lis-thee-sis.
Spondylolisthesis occurs when a vertebra shifts forward (anterior) or backward (posterior). Often, this happens after a fracture in the pars interarticularis—the part of the vertebra that keeps it connected to the bones above and below.
Your spine has 24 vertebrae separated by discs that cushion the bones. Each vertebra connects to the next through facet joints. The pars interarticularis links the upper and lower facet joints. When it fractures, the vertebra can slip.
Spondylolisthesis usually occurs in the lumbar spine, especially at L4 and L5, though it can appear anywhere.
In the image above you see three vertebrae stacked on top of each other. You can see where each connects, as well as the empty facet joints where the other vertebra would sit. The pars interarticularis is the narrow part of the bone that connects the upper and lower facet joints on one vertebra.
Photo By: My Central Fitness
Are Spondylolisthesis and Spondylolysis the Same?
Not quite. Here’s the breakdown:
- Spondylolysis: a fracture in the pars interarticularis, without slippage.
- Spondylolisthesis: slippage of the vertebra, sometimes following spondylolysis.
Think of it this way: spondylolysis can lead to spondylolisthesis, but the two are distinct.
Fun fact: doctors call spondylolysis a “Scotty dog fracture.” On X-ray, the vertebra looks like a Scotty dog, and the fracture occurs at the dog’s neck. If the vertebra slips, it’s sometimes called a “decapitated Scotty dog.”
What Causes Spondylolisthesis?
The main causes include:
- Congenital (genetic weakness in the pars interarticularis)
- Isthmic (fracture leading to slippage)
- Traumatic injury (rare, but possible)
Genetics plays the largest role. Many people have a weakness in the pars interarticularis without knowing it.
Athletes who repetitively extend their spines, such as football linemen or gymnasts, are at higher risk. Car accidents can also cause slippage, though less commonly.
How is Spondylolisthesis Diagnosed?
Diagnosis usually happens after symptoms appear, though you can have spondylolisthesis without symptoms. Slippage can irritate muscles, ligaments, and nerves at the affected level. Common symptoms include:
- Lower back pain
- Stiffness
- Hamstring or back spasms
- Pain radiating down the legs
Doctors begin with an exam, history, and gait assessment. An X-ray usually confirms the diagnosis. If needed, an MRI or CT scan checks for soft tissue or nerve damage.
Slippage is graded on a scale:
- Grade I: 1–25% slip
- Grade II: 26–50% slip
- Grade III: 51–75% slip
- Grade IV: 76–100% slip
How is Spondylolisthesis Treated?
Treatment depends on severity. Most cases respond well to conservative care such as physical medicine and rehabilitation. Surgery—typically spinal fusion—is reserved for severe Grade III or IV slips with instability or nerve damage.
Our focus is on stabilization. Strengthening the core—especially the lower abdominals—protects the spine. Forget crunches; they’re ineffective and sometimes harmful. Instead, we use exercises based on Developmental Kinesiology, which retrain movement patterns we all developed as babies.
See this video for details:
Other key treatments include:
- Segmental mobility: keeping each vertebra moving independently.
- Dynamic stretching: stretching through movement, not isolating one muscle.
- Postural correction: retraining the body as a whole, not just the injured area.
Chiropractic or physical therapy in their most common forms often stop once pain goes away. True treatment must go further—restoring posture and functional movement to prevent recurrence.
Posture and Spondylolisthesis
Posture plays a huge role in spinal health. Poor posture exaggerates spinal curves—lordosis in the lower back or neck, and kyphosis in the mid-back. These distortions compress vertebrae, weaken ligaments and muscles, and increase misalignment, raising the risk of spondylolisthesis.
Posture braces and quick fixes don’t work. Think about it: all babies develop movement the same way, step by step. That developmental path is nature’s design, and it’s the most reliable guide for restoring healthy movement.
We start with proper breathing—just like babies—and build core stability from there.
This video shows you how:
Pelvic Floor Dysfunction and Spondylolisthesis
Here’s something most people miss: the pelvic floor.
Spondylolisthesis in the lumbar spine affects the pelvic muscles, including the psoas and iliacus. These muscles impact both movement and stability. Since the pelvic floor is central to core stabilization, it plays a huge role in recovery.
I recommend reading my blog on How to Get a Healthier Pelvic Floor and Pelvic Diaphragm to learn more.
Photo By: Somatic Movement Center
Get the Right Spondylolisthesis Treatment
Surgery should always be the last option. Ordinary care delivers ordinary results. Instead, we follow nature’s blueprint—revisiting the developmental movement patterns that built our bodies in the first place. If you need help managing your spondylolisthesis, contact us.
We are the designers and directors of our own lives. Let’s design and direct it the way we want to live it.
Dr. Shakib