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Slipped Vertebra (Spondylolisthesis):
Symptoms and Treatments

A photo of Dr Colum Nolan, Senior Consultant Neurosurgeon of Oxford Spine & Neurosurgery Centre

Dr Colum Nolan
Senior Consultant Spine & Neurosurgeon
MB, BCh, BAO, LRCPSI, MRCSI, FRCSI (Neurosurgery)

A “slipped vertebra” usually refers to spondylolisthesis, where one vertebra slips forward over the one below it. This shift can narrow the space where spinal nerves exit, leading to nerve irritation or compression and pain that may travel into the buttock or leg.

How Spondylolisthesis Affects the Lower Back

Spondylolisthesis most commonly occurs in the lumbar spine (lower back). Some people have a slip found on X-ray but feel fine. Others develop symptoms because the slip:

  • Strains the joints and soft tissues in the back, and/or
  • Reduces space for nerves, causing leg symptoms.

The impact depends on factors such as the degree of slip, whether there is instability, and whether the slip contributes to spinal canal or foraminal narrowing.

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Common Causes of Spondylolisthesis

Spondylolisthesis can develop for different reasons. The most common patterns include:

Degenerative (age-related)

Wear-and-tear changes in the discs and facet joints can reduce stability over time, allowing a vertebra to shift.

Isthmic (pars-related)

A small stress fracture or defect in part of the vertebra (pars) can allow slippage. This may begin earlier in life, but symptoms can appear later.

Less common causes

  • Trauma (injury)
  • Congenital (spinal shape differences from birth)
  • Bone weakening from certain medical conditions (uncommon)

Symptoms of a Slipped Vertebra (Spondylolisthesis)

Symptoms vary. They may be mainly back-related, mainly nerve-related, or both.

Lower back symptoms

  • Ache or pain in the lower back
  • Stiffness or tightness, especially with prolonged standing
  • Pain that can worsen with bending backwards or certain movements

Nerve-related symptoms (if a nerve is pinched or irritated)

Spondylolisthesis can narrow the space where nerves exit, and symptoms may travel along the nerve pathway.
Common features include:
  • Shooting/radiating pain into the buttock or leg
  • Tingling or numbness in the leg or foot
  • Weakness in the leg
Some people also notice reduced walking tolerance, or symptoms that fluctuate with posture and activity.

When to seek urgent medical attention

Seek urgent care if you develop:
  • New or worsening leg weakness
  • Numbness around the groin/saddle area
  • Loss of bladder or bowel control
  • Severe pain after a significant fall/accident, fever, or unexplained weight loss
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How Is Spondylolisthesis Diagnosed?

Diagnosis usually involves:

Clinical assessment

A detailed history and examination looking at:

  • Posture and spinal movement
  • Leg strength, reflexes, and sensation
  • Nerve irritation signs

Imaging (when needed)

  • Standing X-rays to assess alignment and the degree of slip
  • Flexion–extension X-rays to check for instability in selected cases
  • MRI if leg symptoms suggest nerve compression, or if symptoms persist
  • CT may be used for bony detail (e.g., pars defects)

Treatments for Spondylolisthesis

Treatment is typically stepwise, guided by your symptoms, function, and whether nerves are involved.

Non-surgical treatment options

Many people improve with conservative care, which may include:
  • Activity modification (avoiding painful positions and repeated heavy loading during flare-ups)
  • Medication for pain or inflammation, when appropriate
  • Heat or cold therapy for symptom relief
  • Physiotherapy to improve core strength, hip flexibility, and movement control (The aim is to support spinal stability and reduce irritation.)
If nerve-related pain is a key feature, additional options may be considered.

Injections (selected cases)

When imaging and symptoms suggest nerve irritation, targeted injections (such as an epidural or nerve root injection) may be used to reduce inflammation and improve pain temporarily, supporting rehabilitation.

When surgery may be considered

Surgery is usually considered when:
  • Symptoms remain significant despite a structured course of non-surgical treatment
  • Pain continues to limit daily activities or walking tolerance
  • There is significant or progressive weakness, or clear nerve compression on imaging
The goals of surgery are to relieve pressure on nerves (decompression) and, when needed, stabilise the spine (fusion).

Frequently Asked Questions about Spondylolisthesis

What is the difference between a slipped vertebra and a slipped disc?

A slipped vertebra is a change in vertebral alignment (bone position). A slipped disc usually refers to a disc herniation. Both can irritate nerves, but they are different problems.

Can spondylolisthesis improve without surgery?

Many cases are managed effectively with conservative treatment, especially when symptoms are mild to moderate, and there is no progressive weakness.

Does the “grade” of slip determine how serious it is?

Not always. The degree of slip matters, but treatment decisions usually depend more on symptoms, function, and nerve findings.

Should I get an MRI?

MRI is most useful when there are leg symptoms suggesting nerve involvement, or when symptoms persist despite initial care.

Medical disclaimer

This page is for general education and does not replace a medical consultation. If you have severe symptoms, worsening weakness, or bladder/bowel changes, seek urgent medical attention.

Our Spine & Neurosurgeon in Singapore
Dr Colum Nolan
MB, BCh, BAO, LRCPSI, MRCSI, FRCSI (Neurosurgery)

Dr Colum Nolan is a Senior Consultant Neurosurgeon with over 20 years of experience, specialising in minimally invasive spine (keyhole) surgery and other spine procedures. 

A graduate of the Royal College of Surgeons in Ireland, Dr Nolan underwent neurosurgical training in Ireland and Australia, followed by a fellowship in complex spine surgery at Addenbrooke’s Hospital, Cambridge, as well as rotations at the Orthopaedic Spine Unit in Norfolk and Norwich Hospital. 

Dr Colum is committed to delivering compassionate, patient-centred care, combining surgical precision with a genuine dedication to improving his patients’ quality of life.

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