Spondylolisthesis (Vertebral Slip)

Specialist treatment for vertebral slippage — Grade I to IV — in Lahore, Pakistan. Conservative management to spinal fusion surgery.

What is Spondylolisthesis?

Spondylolisthesis is a spinal condition where one vertebra (spinal bone) slips forward over the vertebra below it. This slippage can narrow the spinal canal, compress nerve roots, and cause significant back pain and leg symptoms. In severe cases, it destabilises the spine and requires surgical stabilisation.

It most commonly occurs at the L4–L5 or L5–S1 level in the lower back. It affects all ages — young athletes can develop it from stress fractures (isthmic type), while older adults develop it from disc and joint degeneration (degenerative type).

Dr. Waqas Mehdi, FCPS Neurosurgeon at MidCity Hospital Lahore, manages spondylolisthesis across all grades — from conservative physiotherapy programmes to minimally invasive decompression and stabilisation surgery when needed.

Types of Spondylolisthesis

Degenerative (Most Common in Adults)

Caused by disc degeneration and facet joint arthritis — the stabilising structures wear out allowing forward slip. Very common after age 50. Typically at L4–L5. Associated with spinal stenosis.

Isthmic (Young Adults & Athletes)

A stress fracture in the pars interarticularis (a small bone bridge) allows the vertebra to slip. Common in young athletes who do repetitive hyperextension (cricketers, gymnasts, wrestlers). Usually at L5–S1.

Congenital

Present from birth — abnormal facet joint development allows slippage. Rarer. Often discovered in childhood or early adulthood when symptoms begin.

Traumatic

Caused by a fracture of any part of the posterior vertebral arch from acute injury — road accidents, falls. Can be unstable and require urgent surgical stabilisation.

Symptoms of Spondylolisthesis

!Chronic low back pain — often worse with activity

!Pain radiating down one or both legs (sciatica)

!Leg heaviness or cramping when walking

!Need to sit down after walking short distances

!Lower back stiffness, especially in the morning

!Tight hamstrings (leg muscles at the back of thigh)

!Numbness or tingling in feet or legs

!Weakness in legs — difficulty standing on tiptoes

Grading of Spondylolisthesis

The Meyerding grading system classifies spondylolisthesis by how much the upper vertebra has slipped over the lower one. The grade determines treatment.

Grade	Amount of Slip	Typical Symptoms	Surgery Needed?
Grade I	< 25% slip	Usually mild — back pain, some stiffness. Often managed conservatively.	Rarely
Grade II	25–50% slip	Moderate back and leg pain. Physiotherapy often helps but surgery may be needed if conservative care fails.	Sometimes
Grade III	50–75% slip	Significant nerve compression likely. Surgery usually recommended.	Usually
Grade IV	> 75% slip	Severe nerve compression. Surgery strongly recommended.	Yes

Treatment Options

Conservative Treatment (Grade I–II, no nerve compression)

› Physiotherapy — core stabilisation and lumbar strengthening
› Activity modification — avoid hyperextension and heavy lifting
› NSAIDs for pain flares
› Lumbar brace support (short-term)
› Weight loss to reduce spinal loading
› Epidural injection for nerve pain relief

Surgery — Decompression with Fusion

› Indicated for: grade III–IV, progressive neurological deficit, failed conservative care
› PLIF (Posterior Lumbar Interbody Fusion) — most common surgical approach
› TLIF (Transforaminal Lumbar Interbody Fusion) — less muscle disruption
› MIS-TLIF — minimally invasive fusion through small incisions
› Pedicle screw instrumentation for spinal stabilisation
› Nerve decompression (laminectomy/foraminotomy) at time of fusion

Frequently Asked Questions

What is spondylolisthesis and what causes it?

Spondylolisthesis is a spinal condition where one vertebra slips forward over the vertebra below it, narrowing the spinal canal and compressing nerve roots. It is caused by disc and joint degeneration in older adults (degenerative type) or a stress fracture in the pars interarticularis in young athletes (isthmic type).

Who is the best doctor for spondylolisthesis treatment in Lahore?

Dr. Waqas Mehdi, FCPS Neurosurgeon and Assistant Professor at King Edward Medical University (KEMU) and Mayo Hospital, Lahore, is widely regarded as one of the best neurosurgeons in Lahore for spondylolisthesis, treating all grades from conservative physiotherapy to minimally invasive decompression and spinal fusion surgery.

Does spondylolisthesis always require surgery?

No. Most Grade I and II cases (less than 50% slip) are managed successfully without surgery, using physiotherapy, activity modification, and epidural injections. Surgery is usually recommended for Grade III–IV slips, progressive neurological deficit, or when conservative care fails.

What are the warning signs of spondylolisthesis?

Common symptoms include chronic low back pain that worsens with activity, pain radiating down one or both legs (sciatica), leg heaviness or cramping when walking, morning stiffness, tight hamstrings, and in advanced cases, numbness or weakness in the legs.

What surgery is used to treat severe spondylolisthesis?

For Grade III–IV slips or cases with significant nerve compression, decompression with spinal fusion is used — commonly PLIF (Posterior Lumbar Interbody Fusion), TLIF, or minimally invasive MIS-TLIF, combined with pedicle screw instrumentation to stabilise the spine.

Book a Spondylolisthesis Consultation in Lahore

Dr. Waqas Mehdi reviews your X-ray and MRI to grade your slip and recommend the appropriate treatment — most Grade I and II cases are managed without surgery. MidCity Hospital, Lahore, Mon–Sat 6–8 PM.

Call: 0300-8482624 Book Appointment

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Pakistan's trusted neurosurgeon for brain tumor surgery, spine surgery, and all complex neurological conditions. Book your appointment at MidCity Hospital, Lahore.

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