Retrolisthesis is a common spinal condition where one vertebra slips backward relative to the vertebra immediately beneath it. This displacement often occurs in the neck (cervical spine) or the lower back (lumbar spine). The condition frequently causes localized pain, stiffness, or neurological symptoms like numbness and weakness if the slippage compresses nearby nerves or the spinal cord.
What Retrolisthesis Is and How It Develops
Retrolisthesis is defined as the posterior displacement of a vertebral body, the opposite of spondylolisthesis, where the vertebra slips forward. The term itself combines “retro” (backward) and “listhesis” (slippage). A displacement of three millimeters or more is generally considered retrolisthesis.
The condition is often categorized by its underlying cause, which is typically degenerative, resulting from cumulative wear and tear on the spine over time. Degenerative causes include intervertebral discs shrinking or losing height, which destabilizes the spinal segment. Other causes include traumatic injury or congenital factors involving structural abnormalities present from birth.
Retrolisthesis is also classified by its severity based on the percentage of backward displacement. Grade I represents up to 25% slippage, Grade II is between 25% and 50%, and Grade III covers 50% to 75% displacement.
Identifying the Condition: Diagnostic Procedures
Diagnosis begins with a detailed physical examination and a review of the patient’s medical history, focusing on the location, type, and duration of pain and any neurological symptoms. The physical assessment helps determine the patient’s range of motion and identify areas of tenderness or muscle spasm.
Imaging techniques are crucial for confirming the diagnosis and measuring the extent of the vertebral slippage. Plain film X-rays are the primary tool, especially lateral views taken while the patient is standing, since lying down can temporarily reduce the displacement. Specialized flexion-extension X-rays, taken while the patient moves, check for dynamic instability, which is a change in the degree of slippage during movement.
Magnetic Resonance Imaging (MRI) provides detailed images of soft tissues, which is particularly important for assessing potential nerve root compression or spinal cord involvement. MRI visualizes the condition of the intervertebral discs and ligaments that may be contributing to the instability. Computed Tomography (CT) scans offer superior detail of the bony structures, helping to identify any associated fractures, bone spurs, or other structural abnormalities of the vertebrae.
Comprehensive Treatment and Management Options
Treatment for retrolisthesis is highly individualized, depending on the grade of slippage, symptom severity, and the presence of neurological compromise. Most individuals with low-grade retrolisthesis and manageable pain are successfully treated with conservative, non-surgical methods. The goal of initial treatment is to reduce pain and inflammation while improving spinal stability.
Non-Surgical Management
Physical therapy is a foundational component of conservative care, focusing on strengthening the core and paraspinal muscles that support the spine. Targeted exercises help stabilize the affected segment and improve posture, reducing mechanical stress on the vertebrae. Pain management often involves nonsteroidal anti-inflammatory drugs (NSAIDs) to alleviate pain and swelling, alongside muscle relaxants to address muscle spasms.
In cases where pain persists or radiates due to nerve irritation, epidural steroid injections may be administered. These injections deliver anti-inflammatory medication directly to the affected nerves, providing temporary pain relief. Bracing, such as a lumbar support brace, is occasionally prescribed to provide external support and limit movement, helping stabilize the spine during painful episodes.
Surgical Interventions
Surgery is typically reserved for severe cases, such as high-grade slippage, significant neurological deficits (like progressive weakness or loss of bladder control), or when conservative treatment fails after an extended period. The primary surgical goals are to decompress any compressed nerves and stabilize the unstable spinal segment.
A common surgical approach involves a decompression procedure, such as a laminectomy, which removes a portion of the vertebral bone (lamina) to create more space for the spinal cord and nerves. Because decompression alone may further destabilize the segment, it is frequently combined with spinal fusion. Spinal fusion permanently joins two or more vertebrae using bone grafts, screws, and rods to create a single, solid bone structure. This fusion prevents further backward slippage and eliminates instability at the affected level.
Long-Term Outlook: Can Retrolisthesis Be Cured?
The question of whether retrolisthesis can be definitively “cured” depends on the underlying cause. Degenerative retrolisthesis, which results from the natural aging process, is typically managed rather than fully cured. The goal of treatment is to achieve long-term functional improvement and pain resolution.
Individuals with low-grade retrolisthesis often have an excellent prognosis, with conservative care leading to substantial symptom resolution and a full return to normal activities. While the alignment may not be perfectly restored, the spinal segment is stabilized, and the pain is controlled. High-grade or unstable cases that require spinal fusion are stabilized by surgically correcting the alignment, preventing further displacement and neurological damage. The long-term outlook focuses on maintaining spinal health through strengthening exercises and lifestyle modifications to prevent recurrence or progression at adjacent levels.