Spondylolisthesis Treatment in Edison, NJ

Spondylolisthesis treatment at the Spine and Performance Institute in Edison, NJ starts with a conservative-first approach. Spondylolisthesis is a condition in which one vertebra in the spine slips forward over the vertebra below it. It is most common in the lower back. Many people with mild spondylolisthesis manage well without surgery; when the slip pinches nerves or makes the spine unstable and symptoms don’t improve, surgery to decompress the nerves and stabilize the spine can help.

Medically reviewed by Dr. Alok Sharan, MD, MHCDS, board-certified orthopedic spine surgeon, Spine and Performance Institute, Edison, NJ.

What Is Spondylolisthesis?

The spine is a stack of vertebrae held in line by discs, joints and ligaments. In spondylolisthesis, one vertebra moves forward relative to the one beneath it. The slip can narrow the space for the spinal nerves (spinal stenosis) and can make that segment of the spine move more than it should.

Types of Spondylolisthesis

Degenerative: the most common type in adults, usually after age 50. Wear of the disc and facet joints lets the vertebra slip, most often at the L4–L5 level.
Isthmic: caused by a stress fracture or defect in a small bridge of bone called the pars interarticularis (spondylolysis). It often begins in adolescence and is most common at L5–S1.
Other types: congenital (present from birth), traumatic, related to tumors or bone disease, and slips that develop after previous spine surgery.

Grades of Spondylolisthesis

Doctors grade the slip by how far the vertebra has moved forward:

Grade I: up to 25%
Grade II: 26% to 50%
Grade III: 51% to 75%
Grade IV: 76% to 100%
Grade V (spondyloptosis): the vertebra has slipped completely off the one below

Most adults with degenerative spondylolisthesis have a grade I or II slip. The grade alone does not decide treatment; symptoms, nerve compression and stability matter more.

Symptoms of Spondylolisthesis

Low back pain, often worse when standing or arching backward
Pain, numbness or tingling that travels into the buttocks or legs (sciatica)
Leg pain, heaviness or fatigue when walking or standing that eases when you sit or lean forward (neurogenic claudication)
Tight hamstrings
Weakness in the legs or feet

Warning Signs — Seek Immediate Care

Go to an emergency department for new loss of bladder or bowel control, numbness in the groin or inner thighs, or rapidly worsening leg weakness. These can signal severe nerve compression.

Diagnosis

Diagnosis starts with your history and a physical exam. Imaging confirms the slip and shows its effect on the nerves:

Standing X-rays, often including flexion and extension views, to measure the slip and check for abnormal motion (instability)
MRI to show pinched nerves, disc degeneration and spinal stenosis
CT scan when more detail about the bone, such as a pars defect, is needed

Non-Surgical Treatment

Most people with spondylolisthesis start with non-surgical care:

Physical therapy focused on core strength, flexibility and posture
Activity changes that avoid heavy lifting and repeated back-bending
Anti-inflammatory and other pain medications
Epidural steroid injections to calm irritated nerves

Surgical Treatment

Surgery is considered when pain, numbness or weakness continue despite non-surgical treatment, when leg weakness is getting worse, or when imaging shows the spine is unstable. The goals are to relieve pressure on the nerves and to stabilize the slipped segment.

Decompression (laminectomy) to make room for the nerves
Spinal fusion to join the slipped vertebra to the one below so it can no longer move abnormally. Approaches include TLIF, ALIF and XLIF; see lumbar fusion for an overview.

Awake Spinal Fusion

Dr. Sharan performs lumbar fusion under regional (spinal) anesthesia instead of general anesthesia for appropriate patients. This avoids a breathing tube and the after-effects of general anesthesia, and most patients go home the same day. Whether you are a candidate is decided at your consultation. Learn more about awake spinal fusion.

Recovery

After decompression and fusion, most patients are walking the same day. Light activity resumes over the following weeks, and the bones continue to fuse over several months. Physical therapy helps rebuild strength. Your recovery plan depends on your procedure, your health and your job.

Seeing a Spine Surgeon in Edison, NJ

Dr. Alok Sharan treats spondylolisthesis at the Spine and Performance Institute, 35-37 Progress St, Suite B5, Edison, NJ 08820. He is a board-certified orthopedic spine surgeon with more than 20 years of experience, fellowship-trained at NYU Hospital for Joint Diseases, and the author of more than 100 peer-reviewed publications. Learn more about our Edison spine practice or Dr. Sharan’s background.

If you have an MRI or CT scan, you can upload your images before your visit.

Frequently Asked Questions

Can spondylolisthesis get worse over time?

It can, but many slips stay stable for years. Degenerative spondylolisthesis usually progresses slowly, if at all. Worsening pain, new leg symptoms or weakness are reasons to be re-evaluated.

Is spondylolisthesis the same as spondylolysis?

No. Spondylolysis is a stress fracture or defect in the pars interarticularis. When that defect lets the vertebra slip forward, the result is isthmic spondylolisthesis.

Do I need surgery for spondylolisthesis?

Most people don’t. Surgery is usually considered when symptoms continue despite non-surgical treatment, when nerve function is getting worse, or when the spine is unstable.

Can I exercise with spondylolisthesis?

Usually yes. Core-strengthening exercise guided by a physical therapist is a mainstay of treatment. Avoid heavy lifting and repeated back-bending until your doctor clears you.

Is awake spinal fusion an option for spondylolisthesis?

For many patients who need a lumbar fusion, yes. Dr. Sharan performs lumbar fusion under regional anesthesia in Edison, NJ, and most patients go home the same day. Candidacy is decided at consultation.