Understanding Spondylolisthesis: Causes, Symptoms, Diagnosis and Treatment

Spondylolisthesis is a spinal condition where one vertebra slips forward over the one beneath it. This vertebral misalignment can compress nerve roots or the spinal cord itself, leading to varying degrees of discomfort, neurological symptoms, and limitations in movement. Although it can occur at any spinal level, it is most common in the lumbar spine, particularly at L4-L5 and L5-S1.

At Dr. Gilete’s clinic in Barcelona, we regularly evaluate and treat patients affected by spondylolisthesis, especially in cases related to connective tissue disorders such as Ehlers-Danlos Syndrome (EDS), where ligament laxity contributes to instability. When we assess a patient with severe lower back pain or neurological symptoms, spondylolisthesis is often considered among the differential diagnoses.

What Causes Spondylolisthesis?

Spondylolisthesis can have several origins:

  • Degenerative: Most frequent in adults over 50, due to disc and joint degeneration.
  • Isthmic: Often due to a defect or stress fracture in a small bone (pars interarticularis).
  • Congenital: Related to spinal malformation present from birth.
  • Traumatic: Resulting from acute injury to the vertebrae.
  • Pathologic: Secondary to conditions like tumors or infections.

 

In our practice, we often encounter degenerative and isthmic spondylolisthesis, particularly in individuals with connective tissue disorders. In those cases, instability is not only biomechanical, but also influenced by ligament and collagen abnormalities.

 

Symptoms and Impact on Daily Life

Symptoms can vary based on the severity and location of the slippage:

  • Lower back pain
  • Sciatic pain or radiculopathy (radiating leg pain)
  • Tingling or numbness in the legs or feet
  • Muscle weakness
  • Difficulty walking or standing for long periods

 

Patients often report a progressive inability to walk and a need to stop frequently due to pain. These symptoms usually correlate with nerve root compression as the spinal canal narrows.

 

How Is Spondylolisthesis Diagnosed?

Diagnosis typically includes:

  • Physical examination
  • X-rays to detect vertebral slippage
  • MRI or CT scans to assess nerve root compression and disc integrity

 

In cases where patients show complex symptoms or a background of EDS or other rare syndromes, our imaging protocol includes upright MRI, CBCT and neurophysiological evaluation to provide an accurate, dynamic diagnosis.

 

Non-Surgical Treatment Options

Initial management is usually conservative:

  • Physical therapy to strengthen core muscles
  • Anti-inflammatory medications or corticosteroids
  • Epidural steroid injections
  • Bracing in selected cases

 

We integrate these treatments with advanced tools such as neuromodulation and hyperbaric oxygen therapy, part of our non-surgical rehabilitation program for neurospinal patients.

 

When Is Surgery Necessary?

Surgery is considered when conservative measures fail or neurological impairment progresses. The standard surgical intervention is:

  • Spinal fusion, often with laminectomy to decompress nerves
  • Minimally invasive surgery (MIS) whenever possible

 

At our clinic:

“High-speed drilling is performed targeting the compressing laminae. Performed through MIS approaches. May be supplemented by screws or a motion sparing device. Under general anesthesia. Patients are discharged the following day or day 2 though hospital stay can also be between 2 and 5 days and depends on the patient postoperative evolution.”

Pain is usually relieved shortly after surgery, although some patients may still experience residual pain that improves progressively. We follow up our surgical patients weekly and recommend a 10–15 day stay in Barcelona post-discharge to monitor their recovery.

 

Recovery and Prognosis

Recovery varies by case but usually spans 2–6 weeks. In the first 2–3 weeks:

  • Avoid low sitting positions
  • Avoid lifting or carrying heavy objects

 

Our team offers continuous follow-up, adjusting rehabilitation protocols individually to maximize functional recovery. Our multidisciplinary care ensures each patient receives personalized, safe, and comprehensive support.

 

How Our Clinic Can Help

As the only EDS Center of Excellence in Europe accredited by the Ehlers-Danlos Society, our facility offers:

  • Surgical and non-surgical solutions for spondylolisthesis
  • Imaging for accurate diagnoses
  • Personalized consultations, both in-person and via telemedicine
  • Coordinated care by experienced spine surgeons, anesthesiologists, internists and rehabilitation specialists

 

Patients from across Europe, North America and the Middle East trust us to evaluate and treat conditions like spondylolisthesis in the context of complex, rare diseases.

 

FAQs About Spondylolisthesis

 

Can spondylolisthesis heal without surgery?

Mild cases may improve with physiotherapy and lifestyle modification. Surgery is reserved for progressive or severe cases.

What level of physical activity is possible after treatment?

Many patients return to normal activities with some limitations on high-impact sports.

Is the surgery safe?

In expert hands and with proper patient selection, surgery has a high success rate and low complication risk.

What if I have Ehlers-Danlos Syndrome?

Our clinic specializes in treating spondylolisthesis in EDS patients, using techniques that respect their unique tissue fragility.

 

Conclusion

Spondylolisthesis, particularly when associated with underlying conditions like EDS, requires a specialized, multidisciplinary approach. At Dr. Gilete’s clinic, we bring together decades of experience, advanced diagnostics, minimally invasive techniques and compassionate care to help our patients recover movement, autonomy, and quality of life.

If you or a loved one suffers from symptoms compatible with spondylolisthesis, we invite you to request a consultation, either in-person in Barcelona or via telemedicine.

 

 

Reviewed and approved by Dr. Vicenç Gilete, MD, Neurosurgeon  & Spine Surgeon | May 20, 2025

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