Retrolisthesis Charlotte NC | What a Backward Vertebral Slip Means | Clear Life Scoliosis

By Dr. Justin Dick, DC · Clear Life Scoliosis and Chiropractic Center, Charlotte, NC · Published October 28, 2026

Retrolisthesis is a backward shift of one vertebra relative to the one below it. It is common in older adults and often painless: in the Study of Osteoporotic Fractures, 14 percent of 788 women aged 65 and older had a backward slip of 3 mm or more. In that study only retrolisthesis at L3-L4 was associated with more back pain and worse back function. In 125 patients having surgery for an L5-S1 disc herniation, 23.2 percent had retrolisthesis at that level, and it was not linked with worse pain or function before surgery.

I am Dr. Justin Dick at Clear Life Scoliosis and Chiropractic Center in Charlotte, NC. I hold CNMT and ARRT(N)(CT) imaging credentials, and I read for vertebral translation on every lateral film. Retrolisthesis is one of the findings patients most often look up after reading their report.

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How It Is Measured

Retrolisthesis is measured on a lateral radiograph or MRI as the backward displacement of the back edge of one vertebral body relative to the one below. Studies use different thresholds. Vogt and colleagues used 3 mm or more. Shen and colleagues used a displacement of 8 percent or more of the vertebral depth. Because thresholds differ, the same spine can be reported as normal or abnormal depending on the method. Standing and flexion-extension films show whether the slip changes with movement, which a single lying MRI cannot. My post on flexion and extension X-rays explains that test.

Why It Develops

Berlemann and colleagues compared 20 patients with retrolisthesis to patients with forward slips and patients without slips. Segments with retrolisthesis had reduced lumbar lordosis, reduced endplate inclination, and lower disc height, while facet orientation was no different from normal segments. Iguchi and colleagues reviewed radiographs of 3,259 outpatients and found single-level retrolisthesis most often at L2, equally in men and women, unlike forward slips, which favored L4 and women. Jeon and colleagues studied 269 patients and proposed two types: one driven by degeneration in people with a low pelvic incidence, and one that compensates for a forward slip below it in people with a high pelvic incidence.

When It Matters Clinically

Vogt and colleagues found that forward slips of 3 mm or more were common and not linked with symptoms, while retrolisthesis at L3-L4 was linked with more pain and impaired function. Shimizu and colleagues found that 124 women with retrolisthesis had lower physical quality-of-life scores and weaker trunk and thigh muscles than women with forward slips. Shen found no added pain or disability from retrolisthesis in patients with an L5-S1 herniation, possibly because the herniation symptoms dominated. Retrolisthesis is a finding to weigh, not an automatic explanation for pain.

Retrolisthesis After a Car Accident

Most retrolisthesis is degenerative and pre-dates any injury. After a crash, the question is whether the segment moves more than it should, which is assessed with flexion and extension imaging and compared with any prior films. That is reasoning from imaging principles, and my page on spinal instability covers the definitions.

How Dr. Justin Dick Evaluates Retrolisthesis at Clear Life

At our Charlotte office, retrolisthesis is measured on standing films, assessed for motion with flexion-extension views when clinically indicated, and correlated with the exam. Care focuses on trunk strength, segmental motion, and alignment. Progressive neurological deficits are referred for surgical evaluation.

Comparison

Research and Evidence

Evidence tiering: all studies here are cross-sectional or retrospective radiographic cohorts. No randomized trial tests a treatment specifically for retrolisthesis. The two-type model from Jeon and colleagues is a proposed mechanism from observational data. Thresholds for an abnormal slip vary by study.

My own published work includes radiographic assessment after trauma. The cervical rehabilitation case report, Radiographic Sagittal Alignment and Neurological Changes Following Conservative Cervical Structural Rehabilitation After Motor Vehicle Collision in a Patient With Pre-existing Scoliosis: A Case Report (Cureus, 2026, PMID 41783554), describes one patient whose flexion and extension films showed abnormal translational motion in the neck, which decreased on repeat films after 17 visits of conservative care. It is a single case in the cervical spine and does not address lumbar retrolisthesis.

References

1. Vogt MT, Rubin D, Valentin RS, et al. Lumbar olisthesis and lower back symptoms in elderly white women. The Study of Osteoporotic Fractures. Spine. 1998;23(23):2640-7. doi:10.1097/00007632-199812010-00020
2. Shen M, Razi A, Lurie JD, Hanscom B, Weinstein J. Retrolisthesis and lumbar disc herniation: a preoperative assessment of patient function. Spine J. 2007;7(4):406-13. doi:10.1016/j.spinee.2006.08.011
3. Iguchi T, Wakami T, Kurihara A, et al. Lumbar multilevel degenerative spondylolisthesis: radiological evaluation and factors related to anterolisthesis and retrolisthesis. J Spinal Disord Tech. 2002;15(2):93-9. doi:10.1097/00024720-200204000-00001
4. Berlemann U, Jeszenszky DJ, Bühler DW, Harms J. Mechanisms of retrolisthesis in the lower lumbar spine. A radiographic study. Acta Orthop Belg. 1999;65(4):472-7. PMID 10675942
5. Jeon CH, Park JU, Chung NS, et al. Degenerative retrolisthesis: is it a compensatory mechanism for sagittal imbalance? Bone Joint J. 2013;95-B(9):1244-9. doi:10.1302/0301-620X.95B9.31237
6. Shimizu M, Kobayashi T, Chiba H, et al. Physical and radiographic features of degenerative retrolisthesis in Japanese female volunteers: an observational cohort study. Sci Rep. 2023;13(1):396. doi:10.1038/s41598-023-27702-4
7. Dick JM, Paige P. Radiographic sagittal alignment and neurological changes following conservative cervical structural rehabilitation after motor vehicle collision in a patient with pre-existing scoliosis: a case report. Cureus. 2026;18(3):e104584. doi:10.7759/cureus.104584

Frequently Asked Questions

Service Area

Clear Life Scoliosis and Chiropractic Center sees patients from Charlotte NC, Huntersville NC, Ballantyne NC, Matthews NC, Concord NC, Mooresville NC, Rock Hill SC, Fort Mill SC. Families from across the Charlotte region and the South Carolina border communities come to the Rachel Freeman Way office for radiographic scoliosis evaluation with Dr. Justin Dick.

Related Pages

• Flexion and Extension X-Rays
• Translation and Angular Motion on X-Ray
• What Is Spinal Instability
• Pre-Existing Degeneration vs New Injury
• Spine Structure, Pain, and Degeneration
• How to Read a Spine MRI Report
• Stress X-Rays After a Car Accident
• Low Back Pain After a Rear-End Collision
• Radiographic Imaging Credentials
• Dr. Justin Dick Research

Schedule an Evaluation in Charlotte

If your report mentions retrolisthesis and you want to know whether it explains your symptoms, Dr. Justin Dick reviews standing and motion films at our Charlotte office.

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