Spondylolisthesis is a forward slip of one vertebra on the one below. Most slips are found on imaging in people who are not disabled by them. In the Framingham CT study of 188 adults, Kalichman and colleagues found no association between spondylolysis, isthmic spondylolisthesis, or degenerative spondylolisthesis and low back pain. Beutler and colleagues followed 30 people whose pars defects were found in first grade for 45 years; slip progression slowed each decade, nobody reached a 40 percent slip, and progression was not associated with back pain.
I am Dr. Justin M. Dick, DC, at Clear Life Scoliosis and Chiropractic Center in Charlotte, NC. Slips show up on films I review for scoliosis, sports injuries, and car accident cases. This post separates the finding from the problem.
Two Main Types
Isthmic spondylolisthesis follows a defect in the pars interarticularis (spondylolysis), the bony bridge at the back of the vertebra. Kalichman found spondylolysis in 11.5 percent on CT, about three times more often in men, and 21 percent of the bilateral defects had no slip. Degenerative spondylolisthesis comes from arthritis of the facet joints and disc, appears later in life, and in the same study was about three times more common in women, rising from the fifth to the eighth decades.
Natural History
Beutler's cohort began with 500 first graders screened in 1955. Thirty had pars lesions. At 45 years, unilateral defects never slipped, and SF-36 scores were similar to the general population. In older women, Vogt and colleagues found anterolisthesis of 3 mm or more in 29 percent of 788 women aged 65 and older, and it was not associated with back symptoms. These data support watching an incidental slip, not treating it as an emergency.
When Surgery Does Better
The SPORT trial enrolled 304 randomized and 303 observational patients with degenerative spondylolisthesis and spinal stenosis. About 40 percent crossed over in each direction, so the intention-to-treat comparison showed no significant difference. The as-treated analysis favored surgery at 2 years (bodily pain +18.1, physical function +18.3, Oswestry -16.7). Fernandez and colleagues' review of 12 trials also found surgery better beyond 2 years for spondylolisthesis with stenosis. The crossover rate weakens the randomized comparison, and the as-treated benefit is open to selection bias, but the signal for symptomatic stenosis with a slip is consistent.
What Nonsurgical Care Targets
For an incidental or mildly symptomatic slip, care targets trunk control, hip mobility, and loading tolerance. Flexion and extension films tell us whether the segment moves abnormally. My posts on flexion and extension X-rays and spinal instability explain that measurement. Leg weakness, worsening numbness, or bowel or bladder change call for prompt referral.
How Dr. Justin M. Dick, DC Evaluates Slips at Clear Life
At our Charlotte office, a slip is graded on standing films, checked for motion on flexion and extension views, and compared with the neurological exam. Surgical referral is made when stenosis symptoms persist or neurological signs progress.
Comparison
| Question | Finding | Source |
|---|---|---|
| Is a slip linked to back pain? | No association on CT in 188 adults | Kalichman 2009 |
| Do childhood pars defects progress? | Progression slowed each decade; none reached 40% | Beutler 2003, 45 years |
| Slips in women 65 and older | 29%; not linked to symptoms | Vogt 1998, 788 women |
| Surgery vs nonsurgical, slip with stenosis | No ITT difference; as-treated favors surgery at 2 years | SPORT, Weinstein 2007 |
Research and Evidence
Evidence tiering: SPORT is a randomized trial with a parallel observational cohort and heavy crossover; Fernandez a systematic review of trials; Beutler a prospective cohort; Kalichman and Vogt cross-sectional studies. Recommendations on nonsurgical care components are clinical reasoning.
My own published work includes motion analysis on flexion and extension films. The retrospective cervical mechanics study, A Retrospective Cross-Sectional Analysis of Abnormal Cervical Mechanics in Patients With Scoliosis (Cureus, 2025, PMID 41018459), examines abnormal motion in scoliosis patients; it does not study lumbar slips.
References
- Kalichman L, Kim DH, Li L, et al. Spondylolysis and spondylolisthesis: prevalence and association with low back pain in the adult community-based population. Spine. 2009;34(2):199-205. doi:10.1097/BRS.0b013e31818edcfd
- Beutler WJ, Fredrickson BE, Murtland A, et al. The natural history of spondylolysis and spondylolisthesis: 45-year follow-up evaluation. Spine. 2003;28(10):1027-35. doi:10.1097/01.BRS.0000061992.98108.A0
- 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
- Weinstein JN, Lurie JD, Tosteson TD, et al. Surgical versus nonsurgical treatment for lumbar degenerative spondylolisthesis. N Engl J Med. 2007;356(22):2257-70. doi:10.1056/NEJMoa070302
- Fernandez M, Ferreira ML, Refshauge KM, et al. Surgery or physical activity in the management of sciatica: a systematic review and meta-analysis. Eur Spine J. 2016;25(11):3495-3512. doi:10.1007/s00586-015-4148-y
- Dick JM. A retrospective cross-sectional analysis of abnormal cervical mechanics in patients with scoliosis. Cureus. 2025;17(8):e91098. doi:10.7759/cureus.91098
Frequently Asked Questions
What is spondylolisthesis?
A forward slip of one vertebra on the one below. The two main types are isthmic, from a pars defect, and degenerative, from arthritis.
Does spondylolisthesis always cause back pain?
No. A CT study of 188 adults found no association between spondylolysis or spondylolisthesis and low back pain.
Will my slip get worse?
Often not much. In a 45-year study of childhood pars defects, progression slowed each decade and nobody reached a 40 percent slip.
When is surgery needed for spondylolisthesis?
Surgery outperformed nonsurgical care in as-treated analyses for slips with symptomatic spinal stenosis. Leg weakness or bowel or bladder change needs prompt evaluation.
Can a chiropractor help spondylolisthesis?
Dr. Justin M. Dick, DC at Clear Life Scoliosis in Charlotte, NC grades the slip, checks motion on flexion and extension films, and focuses care on trunk control and loading tolerance, with referral when stenosis symptoms persist.
Where can I get spondylolisthesis evaluated in Charlotte, NC?
Clear Life Scoliosis and Chiropractic Center, 8814 Rachel Freeman Way, Suite 103, Charlotte, NC 28278, provides imaging review with Dr. Justin M. Dick, DC. Call 980-368-0766.
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 M. Dick, DC.
Related Pages
- Flexion and Extension X-Rays
- Spinal Instability
- Spinal Stenosis and Scoliosis
- Degenerative Changes
- Scoliosis and Sports
- How to Read Your MRI Report
- Spine Emergencies
- Scoliosis Imaging and Measurement
- Personal Injury Program
- Dr. Justin M. Dick, DC Research
Schedule an Evaluation in Charlotte
If a slip showed up on your films, the grade, the motion, and your exam decide what it means. Dr. Justin M. Dick, DC reviews all three at our Charlotte office.
Dr. Justin M. Dick, DC
8814 Rachel Freeman Way, Suite 103, Charlotte, NC 28278
Phone: 980-368-0766 · Email: office@clearlifescoliosis.com
clearlifescoliosis.com · Book online
Justin Dick
Contact Me
