Degenerative Spondylolisthesis

Definition

Forward slip of one vertebra on the one below from facet joint and disc degeneration, with an intact pars interarticularis. Wiltse type III. The isthmic and paediatric forms are covered under Spondylolysis and spondylolisthesis.

Epidemiology

  • Most common at L4 to L5
  • More frequent in women and after the age of 50 years

Aetiology

  • Facet joint and disc degeneration with loss of restraint to anterior translation
  • Sagittally oriented facet joints at the affected level

Classification

Meyerding grade, slip as a percentage of the vertebral body below

GradeSlip
IUp to 25%
II25 to 50%
III50 to 75%
IV75 to 100%
VSpondyloptosis

Original publication (not indexed in PubMed) Meyerding HW. Spondylolisthesis. Surg Gynecol Obstet. 1932;54:371-7.

Most degenerative slips are grade I or II.

Clinical Features

  • Neurogenic claudication from central canal stenosis
  • L5 radiculopathy from lateral recess stenosis at L4 to L5
  • Mechanical low back pain, worse on standing and extension
  • Palpable step-off between spinous processes

Investigations

  • Standing lateral radiograph to grade the slip and measure sagittal alignment
  • Flexion and extension views for dynamic instability
  • MRI for canal, lateral recess and foraminal stenosis

Management

  • Nonoperative care. Physiotherapy, analgesia and epidural steroid injection. First line for at least 12 weeks
  • Decompression. Laminectomy for leg symptoms from stenosis. In SPORT, surgery gave greater 2 year improvement in pain and function than nonoperative care on as treated analysis, but about 40% crossed over in each direction and the intention to treat result was not significant
  • Decompression and fusion. In 66 patients with stable grade I slips, instrumented fusion gave a greater SF-36 physical gain at 2 years than laminectomy alone (15.2 versus 9.5)
  • The Swedish trial of 247 patients with stenosis, with or without slip, found no benefit from adding fusion (Oswestry 27 versus 24 at 2 years)

Complications

  • Progression of slip after decompression alone
  • Adjacent segment degeneration
  • Pseudarthrosis after fusion

References

Weinstein JN, Lurie JD, Tosteson TD, Hanscom B, Tosteson AN, Blood EA, Birkmeyer NJ, Hilibrand AS, Herkowitz H, Cammisa FP, Albert TJ, Emery SE, Lenke LG, Abdu WA, Longley M, Errico TJ, Hu SS. Surgical versus nonsurgical treatment for lumbar degenerative spondylolisthesis. N Engl J Med. 2007, 356(22), 2257-70. PubMed

Ghogawala Z, Dziura J, Butler WE, Dai F, Terrin N, Magge SN, Coumans JV, Harrington JF, Amin-Hanjani S, Schwartz JS, Sonntag VK, Barker FG, Benzel EC. Laminectomy plus fusion versus laminectomy alone for lumbar spondylolisthesis. N Engl J Med. 2016, 374(15), 1424-34. PubMed

Försth P, Ólafsson G, Carlsson T, Frost A, Borgström F, Fritzell P, Öhagen P, Michaëlsson K, Sandén B. A randomized, controlled trial of fusion surgery for lumbar spinal stenosis. N Engl J Med. 2016, 374(15), 1413-23. PubMed

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 21 October 2026.