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Lumbar Retrolisthesis

What Is Lumbar Retrolisthesis?

Retrolisthesis describes a condition where a vertebra in the spinal column moves backward and misaligns over the one below it.

The spinal column (vertebral column, backbone) comprises a series of interconnected bones that run from the base of the skull to the tip of the tailbone (sacrum). It supports the body's physical structure and protects the spinal cord that runs in the spinal canal that is formed by openings in the vertebrae. Other openings in each vertebra allow nerves to enter and leave the spinal cord and carry messages to and from the brain.

If there is a misalignment of the vertebral bodies, the spinal cord or any of the nerves can be affected. As well, the muscles can become inflamed.

Spondylolisthesis is the medical term that means a vertebra has slipped (spondyl=spine + listhesis=slippage). It is commonly used to describe a vertebra that has slipped anterior, or forward, compared to the vertebra below it.

Retrolisthesis describes a slippage in the opposite direction (retro=backward).

This vertebral slip may happen anywhere in the spinal column, but it is most likely to occur in the cervical and lumbar regions These are the weight-bearing sections of the spinal column. The cervical vertebrae bear the weight of the head, and support it at rest and during movements, while the lumbar spine bears most of the body's weight, distributes it, and provides stability and balance. The thoracic vertebrae are located in the chest and are held stable by the ribs and therefore are less likely to slip.

How serious is retrolisthesis?

The seriousness of retrolisthesis depends on the extent of vertebral slippage or displacement. If the slippage is minimal, there may be little concern and the diagnosis is made as an incidental finding on an X-ray, meaning the X-ray was ordered for a reason other than looking for retrolisthesis.

However, if the retrolisthesis is more severe, it can cause muscle and ligament inflammation causing pain. The displacement may also compress the nerves that leave the spinal cord and affect their function.

In the neck (or cervical spine) retrolisthesis can compress the nerves that supply the sensation and power to the arms leading to a cervical radiculopathy, causing pain, numbness, and weakness in the arms and hands.

In severe cases of retrolisthesis of the cervical spine, the spinal cord itself can be compressed and that can cause numbness, weakness, and issues with balance and walking. If it is left untreated, and the displacement continues, it can cause a condition called cervical spondylotic myelopathy, which can lead to paralysis and death.

If the retrolisthesis occurs in the lumbar spine, then the affected nerves can cause sciatica in the buttock and leg with symptoms of pain, numbness, tingling, and weakness. Because the spinal cord ends at the level of the first or second lumbar vertebra, spinal cord compresses usually do not occur in the lumbar area.

Types and grades of retrolisthesis

Retrolisthesis may be classified into three types based on the position of the vertebra compared to the vertebrae above and below:

Complete retrolisthesis: One vertebra shifts backward compared to the positioning of both the vertebra above and below.

Partial retrolisthesis: One vertebra shifts backward compared to the positioning of both vertebrae above or below.

Stair-stepped retrolisthesis: One vertebra shifts backward compared to the positioning of the vertebra above but moves ahead of the one below.

Retrolisthesis has four grades based on the percentage of the backward displacement of the intervertebral foramina (the spaces between the vertebrae through which the spinal nerves leave the spinal cord). The grades may help determine the instability of the adjacent joints in the spinal column.

Grade I: Up to 25% posterior displacement

Grade II: 25% to 50% posterior displacement

Grade III: 50% to 75% posterior displacement

Grade IV: 75%-100% posterior displacement

Sometimes the classification is simplified as low-grade (I-II) and high-grade (III-IV).

Prevalence of Retrolisthesis

Studies have found that retrolisthesis is more common in older adults and in women. The prevalence of retrolisthesis is also higher in certain populations, such as those with osteoporosis or degenerative disc disease.

According to a study published in Orthopaedic surgery (Da He 2021), the overall prevalence of spondylolisthesis is about 17%. Retrolisthesis is less common than anterolisthesis, which is forward slippage of the vertebra.

Symptoms

The range of symptoms depends on whether it is cervical or lumbar retrolisthesis, its grade, its effect on the surrounding structures, and overall health.

Symptoms of cervical retrolisthesis may include:

Neck pain, stiffness, and limited range of motion

Muscle weakness and fatigue in the shoulders, arms, and hands

Radiating pain in the upper extremities

Numbness and tingling in the arms and fingers

Headaches

High-grade retrolisthesis may have an impact on the spinal cord, and affect the lower body as well, cause pain, weakness, and numbness, and affect balance, coordination, and lower body movements. This is known as cervical spondylotic myelopathy.

Symptoms of lumbar retrolisthesis may include:

Low back pain and spasm

Limited range of motion

Weakness of the abdomen muscles

Sciatica with numbness and tingling radiating from the lower back down the leg(s) to the buttock, hip, knee, and foot

What Causes Lumbar Retrolisthesis?

Factors that increase the risk of developing retrolisthesis include the following:

Osteoarthritis: Years of wear and tear on the back can lead to chronic damage of the ligaments and discs that help keep the back stable

Disc degeneration: With age, the discs located between the vertebrae and help stabilize the back lose water, degenerate, and allow more movement than normal between those vertebrae

Obesity: Increased weight puts stress on the spine

Trauma

Infections

Core muscle weakness and poor posture put increased stress on the spine

Nutritional deficiencies, especially calcium and Vitamin D

How is retrolisthesis diagnosed?

The diagnosis of retrolisthesis is made by a healthcare provider. Usually, time is needed to take a history, look at previous medical records and tests, and perform a physical examination.

If retrolisthesis is a concern, a standing lateral x-ray of the back is the recommended first test. This will allow the radiologist to check the alignment of the vertebrae and also look at any other bony abnormalities that might be present. Often, only the area of the spine that is causing pain is imaged.

An MRI of the spine may be considered, if there is concern that the spinal cord or nerves are potentially at risk or already damaged.

Your doctor may order imaging tests to confirm the diagnosis and determine the severity of your retrolisthesis. The most common imaging tests used include:

X-rays: X-rays can show the alignment of the vertebrae and any signs of slippage.

CT scan: A CT scan can provide detailed images of the bones and soft tissues in your back, allowing your doctor to see any damage or abnormalities.

MRI: An MRI can show the spinal cord and nerves, as well as any herniated discs or other soft tissue abnormalities.

Treatment

Nonsurgical treatment
Options may include the following:

Medications

Nonsteroidal anti-inflammatory medicines (NSAIDs) to treat back discomfort and inflammation

Muscle relaxants to relax the muscles

Physical therapy

Bracing

Microcurrent therapy

Massage

Ice/heat

Lifestyle modifications

Weight loss

Exercise programs

Using proper ergonomics to lift, or avoiding heavy lifting

Surgical treatment
Surgery is considered when all the other nonsurgical methods fail. These are some of the surgical goals:

Decrease pain

Reduce slippage

Treat instability

Maintain or restore neurological function

Prevention

Retrolisthesis cannot always be prevented. For instance, a person may suffer from an injury that throws their back out of alignment. Others may experience retrolisthesis due to genetic causes.

The majority of people can prevent retrolisthesis by adhering to some of these fundamental advice:

Maintain a healthy weight and diet for strong bones and less back pain.

Pelvic tilt exercises can help you build up your core muscles, which will help to relieve back strain.

Maintain proper posture while standing and sitting.

Practice yoga to strengthen your core, improve your posture, and align your back.

Avoid overextending or putting too much weight on the back to prevent strain.

Smoking should be avoided because it can eventually harm your joints.

How Does Retrolisthesis Affect Ability To Work?

If you suffer from retrolisthesis you could experience a bulge on your back, limited range of motion, back pain and pain in nearby areas.

Retrolisthesis is one of several disorders of the spine and it can make it too painful to sit or stand for prolonged periods of time.

In this case, if your job requires you to sit or stand, your ability to work without experiencing pain could be near to completely impossible with grade 1 retrolisthesis through grade 4 retrolisthesis.

FAQ's about retrolisthesis

What causes retrolisthesis and who is at risk?

Most often retrolisthesis occurs because of osteoarthritis and degenerative disc disease.

Other risk factors include the following:

Advanced age

Congenital conditions that affect the spinal column

Osteoporosis arthritis

Tobacco use

Obesity

Sedentary lifestyle

Calcium and vitamin D deficiency

What are the different grades of retrolisthesis?

Retrolisthesis grading is based on the extent of vertebral displacement.

Grade 1 retrolisthesis is 25% slippage

Grade 2 is 25-50% displacement

Grade 3 is 50-75% displacement

Grade 4 is the most severe at 75-100% displacement

How does retrolisthesis affect the spine and overall health?

Retrolisthesis may cause misalignment of the spinal column, and in severe cases, can compress the spinal cord, nerves, and nerve roots. This can cause pain, muscle weakness, tingling, and numbness, affect mobility, balance, and coordination, and may lead to disability. Overall health may be impacted, and quality of life diminished for a person with chronic pain and impaired mobility. Nerve damage can affect bladder function and intestine motility.
What are the common symptoms of retrolisthesis?

Common symptoms of retrolisthesis include back or neck pain depending on which vertebra is affected, radiating pain, muscle weakness, limited range of motion, balance and coordination issues, difficulty with walking, and numbness and tingling in the extremities.
How is retrolisthesis treated, and can it be reversed?

Treatment is based on the grade and severity, as well as the individual's age and health. At a younger age, retrolisthesis is most often treated with physical therapy, though surgery is a possibility in some cases. In older patients with age-related degeneration, treatment is aimed at pain management, symptom control, and prevention of further damage. Treatments usually include medication to decrease pain, inflammation, and spasms, supportive braces, and physical therapy. Surgery is considered when other treatment options have failed or when the spinal cord is potentially at risk for damage.

While the progression of retrolisthesis can be prevented and restoration of a more normal alignment of the vertebral bodies is possible, especially in younger patients, it is a disease unlikely to be cured.
What is the difference between retrolisthesis and spondylolisthesis?

Both terms refer to the displacement of vertebrae but in different directions. When a vertebra slips backward, it is called retrolisthesis. When it slips forward, it is called spondylolisthesis. Retrolisthesis is less common than spondylolisthesis.
Is surgery necessary for treating retrolisthesis?

Surgery is the last resort treatment and only if non-surgical treatments fail to adequately alleviate pain and other symptoms. Surgery is often considered if there is a risk for neurological damage. Most cases of retrolisthesis can be treated effectively with medication, physical therapy, and lifestyle modifications.
Can physical therapy help with retrolisthesis?

Physical therapy is one of the primary treatments for retrolisthesis. It helps strengthen the core muscles that support the backbone and reduce the pressure on it.
How serious is retrolisthesis and can it lead to permanent damage?

Low to medium-grade retrolisthesis can be treated and managed well with physical therapy and lifestyle modifications. Severe grades can be serious and may lead to chronic pain, spinal cord compression, and nerve damage which can impact mobility, balance, and quality of life.

Summary

Retrolisthesis is a medical term that refers to the backward displacement of a vertebral body in relation to the one immediately below it in the spinal column. It is a type of spondylolisthesis, which refers to any abnormal forward or backward movement of one vertebra in relation to another.

This condition can occur in any part of the spine but is most commonly seen in the cervical (neck) and lumbar (lower back) regions.

Some common symptoms include back or neck pain, stiffness, muscle weakness, numbness or tingling, and difficulty with mobility or balance. Treatment options for retrolisthesis depend on the severity of the condition, but may include medication, physical therapy, or surgery.

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Most recent revision June 12, 2025 09:28:33 PM