Spondylolisthesis - Diagnosis - Therapy

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Spondylolisthesis - Diagnosis - Therapy
Spondylolisthesis - Diagnosis - Therapy
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Spondylolysis and Spondylolisthesis: Diagnosis & Therapy

In many cases, spondylolysis and mild forms of spondylolisthesis (sliding vertebrae) do not cause any particular symptoms. When symptoms persist, they usually appear as pain in the lower back. The more a vertebra shifts, the more the surrounding muscles, tendons and ligaments are stressed.

To diagnose back pain, the doctor first collects the medical history and performs a physical examination. The spine, hip and knee joints are examined and checked for pain and tenderness. A visible indentation of the skin on the spine can be an indication of the displacement of a vertebra.

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  • How is the diagnosis made?
  • Sliding vertebrae as an incidental finding
  • How is spondylolysis or spondylolisthesis treated?
  • How is the aftercare carried out?
  • Whom can I ask?
  • How are the costs going to be covered?

How is the diagnosis made?

The suspicion of spondylolysis or spondylolisthesis (vertebral sliding) is clarified by X-ray examinations. Side x-rays provide information about the degree of spondylolisthesis or the presence of spondylolysis. Ev. the doctor can prescribe further imaging procedures (e.g. MRI, CT) for a more precise diagnosis. This can also be necessary in order to rule out other pathological causes of the symptoms, e.g. cauda equina syndrome, abscess.

Sliding vertebrae as an incidental finding

If a slight sliding of the vertebra is discovered by chance during an X-ray and there are no symptoms, no therapy is necessary. The doctor can recognize and treat any deterioration in good time through regular checks.

How is spondylolysis or spondylolisthesis treated?

The therapy depends on the patient's complaints, the form of the disease, the diagnosed severity, any neurological symptoms and other factors, e.g. age, physical activity, progression of the vertebral slippage. For more information, see Spondylolysis and Spondylolisthesis: What is it?

Non-operative (conservative) therapy

In most cases, non-surgical (conservative) therapy for at least three months is sufficient to alleviate the symptoms or to cure spondylolysis. Afterwards, the patient can usually resume their usual activities. The following measures are part of non-surgical therapy:

  • Sports break or avoidance of movements that lead to a hollow back.
  • Physiotherapy with exercises to strengthen the core muscles and stabilize the spine, which should also be performed regularly according to instructions.
  • Pain reliever anti-inflammatory drugs (NSAIDs) used to relieve pain,
  • Ev. temporary immobilization of the affected area of ​​the spine, e.g. with a support bandage, plaster cast or corset.

The doctor checks the success of the treatment through regular x-ray examinations. Ev. the patient can be advised on how stress on the vertebral area can be avoided in everyday life, e.g. at work, at home. Consultation can be given by the doctor, the physiotherapist or the occupational therapist.

Operative treatment

If the conservative therapy is unsuccessful after several months and the patient is in severe pain, the doctor can suggest an operation. Among other things, this is intended to alleviate the symptoms and improve mobility. An operation may also be indicated if the sliding of the vertebrae deteriorates to Meyerding grade II and higher.

Advanced neurological symptoms are an indication for rapid surgery to avoid permanent nerve damage.

Different operative procedures are used depending on the individual requirements.

  • Reconstruction of the interarticular portion: In the case of acute spondylolysis with persistent, severe pain in children and adolescents, surgery may be indicated to “repair” the gap in the vertebral arch. The gap is filled with the body's own bone pieces and the affected vertebral joint is stabilized using screws, pins or loops. This should allow the gap to heal.
  • Stiffening operation (spondylodesis): The affected, unstable vertebra is stabilized or stiffened in the spine. This operation is indicated if there is other damage to the vertebral joint and intervertebral discs. During the operation, the position of the vertebra that has slipped forward may be corrected (reduction) and the nerve roots relieved. A stiffening operation, possibly with correction of the vertebral position, may also be necessary in young patients with severe vertebral sliding (Meyerding grade III and IV).

A metal construction is attached to the vertebral body for stabilization. Metal cages (cages) between the vertebral bodies correct the slipped vertebrae and expand the intervertebral space in order to avoid nerve irritation and to achieve the natural curvature (lordosis) of the spine). The stiffening of a vertebral joint can result in a slight reduction in the mobility of the back.

How is the aftercare carried out?

Physiotherapy after the operation aims to strengthen the back and keep it flexible. Approx. Rehabilitation can be prescribed three months after the operation to improve the stability of the spine and further strengthen the back muscles.

Whom can I ask?

Do you or your child have problems with the spine, complain of recurring back pain, which under certain circumstances can extend to the legs? For clarification, you can contact the following offices:

  • General Practitioner,
  • Pediatrician,
  • Specialist in orthopedics and traumatology,
  • Specialist in orthopedics and orthopedic surgery and
  • Specialist in physical medicine and general rehabilitation.

How are the costs going to be covered?

The e-card is your personal key to the benefits of the statutory health insurance. All necessary and appropriate diagnostic and therapeutic measures are taken over by your responsible social insurance agency. A deductible or contribution to costs may apply for certain services. You can obtain detailed information from your social security agency. Further information can also be found at:

  • Right to treatment
  • Visit to the doctor: costs and deductibles
  • What does the hospital stay cost?
  • Prescription fee: This is how drug costs are covered
  • Rehabilitation & cure
  • Medical aids & aids
  • Health Professions AZ

and via the online guide to reimbursement of social insurance costs.

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