Types of Spondylolisthesis: A Complete Guide

Spondylolisthesis is a spinal condition where one vertebra slips forward over another, often causing back pain, stiffness, or nerve-related symptoms. While it may sound serious, the condition ranges from mild to severe and can be effectively managed with timely diagnosis and the right treatment approach.

Understanding the types of spondylolisthesis helps identify the underlying cause – whether it’s congenital, degenerative, or trauma-related – and choose the most suitable management plan. In this guide, we’ll break down the different types of spondylolisthesis, explain how they develop, and highlight the most common type of spondylolisthesis seen in both young athletes and older adults.

What Is Spondylolisthesis?

The spine is made up of vertebrae stacked one on top of another, connected by joints, discs, and ligaments. Spondylolisthesis occurs when one of these vertebrae slips forward out of alignment. This slippage can cause nerve compression, lower back pain, or leg discomfort, depending on its severity.

Doctors classify spondylolisthesis by both cause (why it happens) and severity (how far the vertebra has slipped). Severity is measured using the Meyerding Grading System, which ranges from:

• Grade I: 1–25% slippage

• Grade II: 26–50%

• Grade III: 51–75%

• Grade IV: 76–100%

• Grade V (Spondyloptosis): More than 100%

The cause-based classification, known as the Wiltse Classification, includes six main types of spondylolisthesis.

The Six Major Types of Spondylolisthesis

Each type has distinct origins, risk factors, and patient profiles. Here’s a closer look:

1. Dysplastic (Congenital) Spondylolisthesis

Description:
This type develops due to a birth defect in the spine, usually involving the lower vertebrae or sacrum. Abnormal bone formation makes the spine less stable, allowing a vertebra to slip forward over time.

Who It Affects:
Children and young adults.

Features:

• Present from birth, though symptoms may appear later.

• May cause rapid progression during growth spurts.

• Often associated with pelvic or spinal structural abnormalities.

Treatment:

• Observation and physiotherapy for mild cases.

• Bracing in children to prevent progression.

• Surgery for severe deformity or nerve compression.

2. Isthmic Spondylolisthesis

Description:
The most common type of spondylolisthesis in adolescents and young adults, isthmic spondylolisthesis, results from a defect or stress fracture in the pars interarticularis – a small bone segment that connects vertebrae.

Who It Affects:
Teenagers, young athletes, and individuals engaged in sports involving hyperextension (like gymnastics, football, or weightlifting).

Features:

• Lower back pain during activity.

• Tight hamstrings or limited flexibility.

• Pain that worsens when standing or bending backward.

Subtypes:

• Type IIa: Repetitive stress fracture.

• Type IIb: Bone elongation from microfractures.

• Type IIc: Acute trauma-induced fracture.

Treatment:

• Rest and physiotherapy-based strengthening exercises.

• Core stabilization and posture correction.

• Surgery only if conservative management fails.

3. Degenerative Spondylolisthesis

Description:
The most common type of spondylolisthesis in older adults, caused by age-related wear and tear of the discs and joints. As the spine loses flexibility, vertebrae may slip forward – most often between the L4 and L5 levels.

Who It Affects:
Adults over 50, especially postmenopausal women.

Features:

• Gradual onset of lower back pain.

• Leg pain or numbness (similar to sciatica).

• Stiffness and reduced mobility.

Treatment:

• Physical therapy and low-impact exercises for spondylolisthesis to improve stability.

• Anti-inflammatory medications for pain relief.

• Surgery for severe nerve compression or instability.

Degenerative spondylolisthesis is often associated with arthritis, osteoporosis, or disc degeneration and progresses gradually.

4. Traumatic Spondylolisthesis

Description:
This type results from a fracture or dislocation of the vertebra caused by trauma. Unlike the isthmic type, the fracture doesn’t involve the pars interarticularis.

Who It Affects:
People of any age who have followed accidents, falls, or sports injuries.

Features:

• Sudden back pain following injury.

• Possible nerve involvement or mobility restriction.

Treatment:

• Immediate medical evaluation and imaging.

• Bracing or surgical stabilization if slippage is severe.

• Physiotherapy after healing to restore strength and posture.

5. Pathologic Spondylolisthesis

Description:
This rare form occurs when the spine is weakened by diseases such as tumors, infections, or metabolic bone disorders.

Who It Affects:
Children or adults with medical conditions affecting bone integrity.

Features:

• Unusual vertebral damage or collapse visible on imaging.

• May occur at multiple spinal levels.

• Rapid progression due to weakened bone structure.

Treatment:

• Treating the underlying disease (antibiotics, cancer therapy, or bone-strengthening medication).

• Surgical stabilization if the spine becomes unstable.

6. Post-Surgical (Iatrogenic) Spondylolisthesis

Description:
Develops after spinal surgery, particularly after procedures that remove too much bone or disc tissue, reducing stability.

Who It Affects:
Patients who have undergone previous spinal decompression or fusion surgery.

Features:

• Localized pain and instability after surgery.

• Visible vertebral slippage on imaging.

Treatment:

• Bracing or physiotherapy in mild cases.

• Revision surgery is considered if instability causes significant symptoms.

Which Are the Most Common Types of Spondylolisthesis?

Among the different types of spondylolisthesis, the two most common are:

1. Isthmic Spondylolisthesis – prevalent among young athletes and active individuals.

2. Degenerative Spondylolisthesis – most frequent in older adults, often due to age-related changes.

Both types share similar symptoms like lower back pain, stiffness, and leg discomfort, but their causes differ significantly – activity-related stress fractures versus spinal degeneration.

Diagnosing the Type and Severity

Diagnosis includes a thorough physical exam and imaging:

• X-rays: Reveal vertebral alignment and degree of slippage.

• MRI or CT scans: Assess nerve compression and structural damage.

• Bone scans: Useful for detecting stress fractures or underlying disease.

Proper identification of the spondylolisthesis type ensures targeted treatment and better recovery outcomes.

Treatment Overview for All Types

While treatment varies by cause and severity, most cases of this condition improve without surgery.

Non-Surgical Options:

• Physiotherapy: Strengthens core and back muscles for stability.

• Lifestyle Modifications: Weight management, ergonomic posture, and avoiding strain.

• Medications: Pain relief and anti-inflammatory drugs.

• Bracing: Short-term support during recovery in young patients.

Surgical Options:
Reserved for severe instability or nerve compression. Common procedures include spinal fusion and decompression surgery, aimed at restoring alignment and relieving pressure on nerves.

Sancheti Hospital: Advanced Care for All Types of Spondylolisthesis

At Sancheti Hospital, our team of orthopedic and spine specialists provides comprehensive diagnosis and treatment for every form of spondylolisthesis – from early-stage cases to complex deformities.

We offer non-surgical solutions, including guided physiotherapy, targeted exercises for spondylolisthesis, and lifestyle counseling, as well as advanced surgical options when necessary.

Whether you’re dealing with isthmic spondylolisthesis from sports or degenerative changes due to age, Sancheti Hospital ensures precise diagnosis, effective management, and long-term spinal wellness.

Take the first step toward pain-free mobility – schedule a consultation today and restore strength to your spine.