An Overview of Spinal Degenerative Spondylolisthesis and How It Causes Back Pain

spinal stenosis

In the world of spinal arthritis and spinal degeneration, one of the most common problems seen with aging is degenerative spondylolisthesis. The "spondy" part refers to the spine, and "listhesis" refers to slippage. As a person's ages and the spine experiences arthritis, there is a cascade of degeneration that occurs in the following steps. The steps are not singular events, there is considerable overlap in occurrence.

1. Degenerative Disc Disease


2. Facet Joint Arthritis


3. Facet Joint Instability


4. Intervertebral segment instability


5. Slippage of one vertebrae on another

As the spinal disc degenerates, the facet joints of the spine see increased and abnormal stresses from what is typically seen. This creates facet joint arthritis by the bony elements of the joint doing what they do best - grow bone. Optimally they would grow more cartilage, creating joint lubrication and preventing arthritis. But the human body loses its ability to keep up with necessary cartilage growth as we age, so it turns to growing bone because it's always good at that.

The bony overgrowth in the facet joint is something that is not needed or desirable and creates instability in the spinal segment. This leads to slippage of one vertebrae on another. The slip is categorized by the percent slip of the vertebral body on the one below. If it's less than 25% it's a Grade 1 slip. If it's 25-50%, it's a Grade 2. If it's 50-75%, it's a Grade 3. And 75-100% is a Grade 4. By and large for the degenerative kind of spondylolisthesis, the slips are Grade 1 or Grade 2.

As a result of the slippage, patients may begin to have an increasing amount of back pain. This can be from the arthritis in the facet joints, the mechanical instability experienced, the degenerative disc disease, or a combination of all three.

Another consequence of the slippage with degenerative spondylolisthesis is that the spinal canal may see a decrease in cross sectional area, leading to spinal stenosis with resultant leg pain, sciatica, and buttock and hip pain.