From the Research
Anterolisthesis is a spinal condition where a vertebra slips forward over the vertebra below it, typically occurring in the lower back (lumbar spine) and graded on a scale from Grade 1 (mild slippage) to Grade 4 (severe slippage). This condition can result from degenerative changes in the spine due to aging, trauma, congenital defects, or stress fractures in the vertebrae 1. Symptoms often include lower back pain, stiffness, muscle tightness, and in more severe cases, nerve compression leading to pain, numbness, or weakness radiating down the legs.
Causes and Risk Factors
The condition occurs because the supporting structures of the spine—including discs, facet joints, and ligaments—weaken or become damaged, allowing abnormal movement between vertebrae 2. Regular exercise to strengthen core muscles, maintaining proper posture, and avoiding activities that strain the lower back can help manage symptoms and prevent progression.
Treatment Options
Treatment depends on severity and may include:
- Physical therapy
- Pain medications like NSAIDs
- Activity modification
- In severe cases, surgical intervention to stabilize the spine 1. According to the North American Spine Society Appropriate Use Criteria, physical therapy had an adjusted mean of 7.66, epidural steroid injections 5.76, and surgery 4.52, indicating that physical therapy is appropriate in most scenarios, especially in patients with back pain and no neurological deficits 1.
Diagnosis and Management
The diagnosis of spondylolisthesis should be determined by an upright x-ray 1. For most clinical scenarios, physical therapy is the most appropriate initial treatment, while surgery is generally more appropriate for patients with neurological deficits, higher disability scores, and dynamic spondylolisthesis. Epidural steroid injections are most appropriate in patients with radiculopathy 1.