Before discussing spondylolisthesis treatment, let us answer the question: what is spondylolisthesis? The vertebrae that make up our spine are stacked on top of each other in an orderly alignment. Normally the front and back edges of each vertebra line up with the edges of the vertebra above and below it. The vertebrae are connected to each other by the discs at the front and the facet joints at the back. Spondylolisthesis is the displacement of one vertebra over another, usually forward. The most common causes are age-related degeneration (wear) of the discs and facet joints, previous spine operations and trauma. As a result of this slippage the spinal canal narrows (spinal stenosis) and the spinal cord and nerves passing through it become compressed. This causes complaints such as pain in the lower back and both legs, numbness and burning, and difficulty walking.
If the slipped vertebrae are mobile, spondylolisthesis must be treated surgically. In spondylolisthesis treatment, the aim of surgery is to immobilise the two slipped vertebrae so that they fuse together (fusion). In some patients this fusion occurs by itself (spontaneous fusion); these patients do not need such a fusion operation. However, because the slippage narrows the spinal canal, they should be assessed and treated like patients with spinal stenosis. (spinal stenosis treatment)
The aim of spondylolisthesis surgery is to immobilise the two slipped vertebrae so that they fuse together (fusion). This fusion is completed in the months after the operation. For the fusion to be faster and stronger, the mobile slipped vertebrae must be fixed to each other (fixation). Various systems, such as the screw-and-rod system, are used for this (spinal instrumentation). The general name of this operation performed in spondylolisthesis treatment is spinal instrumentation and fusion, but there are several variants. Among them, the technique that provides the strongest and fastest fusion is transpedicular fixation with interbody fusion. Spondylolisthesis operations that used to be performed open have in recent years also been performed as closed (minimally invasive) procedures. Our clinic has a team highly experienced in both techniques. For detailed information about closed spondylolisthesis surgery and our three-dimensional animation video, please click.
Appointments & practical information
How do I book an appointment?
You can send your appointment request via WhatsApp, by phone or through the contact form. Briefly describing your complaint and the times that suit you speeds things up; we respond as quickly as possible.
What should you bring to the consultation?
If available, bring your recent MRI and CT images, previous test and surgery reports, and a list of the medication you take regularly. This makes the assessment considerably easier.
What happens at the first consultation?
We listen to your complaints and history, perform a neurological examination and review your existing images together. Treatment options are then planned with you, taking your expectations and lifestyle into account.
Second opinion
If you have been diagnosed or advised to have surgery elsewhere, you can book an appointment for a second opinion with your existing images and reports.
Reach out for your questions and appointment requests. We reply as soon as possible.
Spondylolisthesis is the forward or backward displacement of one vertebra over the vertebra below it. This condition, called "spondylolisthesis" in medicine, disrupts the alignment of the spine, leading to narrowing of the nerve canals and spinal instability (looseness).
What Are the Symptoms of Spondylolisthesis (Slipped Vertebra)?
The most typical symptom is severe lower back and hip pain that increases with standing and walking and eases when sitting. In addition, numbness, burning, and a cramping sensation in the legs occur, and in advanced cases balance disorders that we call a "waddling gait" are seen. At the level where the slippage occurs, a step-like formation can be felt in the lower back when examined from the outside.
What Causes Spondylolisthesis (Slipped Vertebra)?
Its causes vary depending on the type: it can arise from congenital bone weaknesses (dysplastic), age-related joint wear (degenerative), small fractures caused by repetitive stress (isthmic – especially in athletes), or as a result of severe trauma.
Does Spondylolisthesis (Slipped Vertebra) Cause Leg Pain?
Yes, one of the most challenging symptoms of spondylolisthesis is leg pain. As the slippage progresses, the canal through which the nerves pass narrows, and the nerve roots come under mechanical pressure. This causes pain radiating from the hip down to the heel, sciatica-like complaints, and numbness.
What Is the Treatment for Spondylolisthesis (Slipped Vertebra)?
Treatment is planned according to the degree of slippage and the patient's complaints. In the early stages, rest, a brace, physical therapy, and pain injections are applied. However, in progressive slippages, severe nerve compression, or instability, surgical fixation of the vertebrae (fusion) is the most effective solution.
Can Spondylolisthesis Be Corrected Without Surgery?
Non-surgical methods can relieve the pain and improve the patient's quality of life, but it is not medically possible to return a slipped bone to its original position or to fix it there without surgery. Non-surgical treatment aims to stop the progression of the slippage and to manage the symptoms.
If I Don't Have Spondylolisthesis Surgery, Am I at Risk of Paralysis?
Not every spondylolisthesis results in paralysis. However, in cases where the degree of slippage increases, the nerve compression worsens, and the condition is nonetheless left untreated, permanent loss of strength in the legs, urinary incontinence, and serious walking disorders (a partial paralysis picture) can develop.
Does Newly Started Spondylolisthesis Require Surgery?
No, in newly started, low-grade (Grade 1) slippages, surgery is usually not the first option. At this stage, physical therapy and close follow-up to strengthen the lower back muscles and provide stabilization can be sufficient.
Does Spondylolisthesis Affect a Herniated Disc?
Yes, because spondylolisthesis disrupts the load distribution in the spine, it causes excessive load to be placed on the disc at that level. This in turn leads to the disc deforming rapidly and to the formation of a herniated disc (disc herniation) or to the worsening of an existing herniation.
Can Someone With Spondylolisthesis Do Sports?
Yes, but one must be selective. Weightlifting that places excessive load on the spine, hard contact sports, or intense backward-bending movements should be avoided. Pilates, controlled yoga, and rehabilitation exercises performed under a doctor's supervision, on the other hand, are beneficial.
Is Swimming Good for Spondylolisthesis?
Swimming is one of the most ideal sports for patients with spondylolisthesis. The buoyancy of the water eliminates the load on the spine, which allows the nerves to relax and the lower back muscles to strengthen safely.
Must a Metal Implant ("Platinum") Always Be Inserted in Spondylolisthesis?
If the spine continues to slip in a mobile manner (instability), merely relieving the nerve is not enough; the area needs to be stabilized. In this case, the use of screw and rod systems (instrumentation), popularly known as "platinum," is the standard treatment method.
Can We Treat Spondylolisthesis With a Brace?
A brace is used, especially during acute painful periods, to support the lower back and restrict movement. However, long-term use can weaken the lower back muscles. A brace is a supportive aid; it is not a primary treatment tool that completely cures the slippage.
What Is the Difference Between Spondylolisthesis and a Herniated Disc?
A herniated disc is the displacement of the soft disc between the vertebrae. Spondylolisthesis, on the other hand, is the displacement of the vertebral bone itself as a whole. Compared to a herniation, the slippage is a more structural problem and one that generally disrupts stability more.
What Causes Spondylolisthesis and Who Is at Risk?
Workers who carry heavy loads, gymnasts, weightlifters, and elderly individuals with osteoporosis (bone loss) are at high risk. It is also frequently seen in people whose spinal joints are genetically weak.
Why Are Dynamic X-rays (Flexion & Extension) Requested in the Diagnosis of Spondylolisthesis?
A static MRI or X-ray shows the degree of slippage but does not show whether the slippage is "mobile" (unstable). X-rays taken while bending forward and backward are critical for determining how much the spine slips during movement and for clarifying the decision for surgery.
Must Every Spondylolisthesis Necessarily Be Operated On?
Absolutely not. If the patient's pain is under control, there is no neurological loss, and the slippage is not progressing, non-surgical follow-up (conservative treatment) is the most correct approach.
Which Grades of Spondylolisthesis Can Be Followed Without Surgery?
Cases that are generally Grade 1 (slippage of less than 25% of the vertebra) and clinically stable can be followed without surgery through physical therapy and periodic check-ups.
Does Wearing a Brace Stop or Cure Spondylolisthesis?
A brace does not "cure" the slippage. It only helps reduce the pain by restricting the mechanical movement in that area and provides comfort to the patient during the recovery process.
How Effective Are Non-Surgical Methods (Epidural Injection, RF) for Pain in Spondylolisthesis?
These methods provide a success rate of 70-80% in relieving leg and lower back pain caused by nerve root compression. They are very valuable alternatives for patients who do not want to undergo surgery or who have a high surgical risk.
How Is Spondylolisthesis (Lumbar Slippage) Surgery Performed?
The surgery is usually performed under general anesthesia. First, the compressed nerves are relieved using microsurgery (decompression). Then, titanium screws and rods are placed to align and stabilize the slipped vertebrae. Bone grafts are inserted in between so that the vertebrae fuse together (fusion).
Can the Slippage Recur After Spondylolisthesis Surgery?
If the screw fixation and fusion (bony union) have been successfully achieved, a recurrence of slippage at the same level is not a medically expected outcome. The surgery completely freezes that level.
After Spondylolisthesis Surgery, Will My Body Perceive the Screws as a Foreign Substance and Reject Them?
No. The materials used in surgery are biocompatible titanium alloys. The likelihood of the body "rejecting" these materials or causing an allergy is virtually nil. A "rejection" reaction like that seen in organ transplantation does not occur.
Will the Screws Placed During Spondylolisthesis Surgery Prevent Me From Having an MRI for Another Illness?
No. Modern titanium screws are "MRI-compatible". After the procedure you can safely have an MRI for any part of your body; only a slight glare (artifact) may appear on the image in the area of the screws.
What Material Are the Screws Placed in My Body During Spondylolisthesis Surgery Made Of?
They are usually titanium-aluminum-vanadium alloys, which are also used in the aerospace and aviation industry — very durable, lightweight, and fully compatible with the body.
After Screws Are Placed During Spondylolisthesis Surgery, Will I Walk Like a Robot?
This is the biggest misconception. The majority of the spine's overall movement comes from the hips and the other vertebral levels. Fixing one or two levels does not restrict the patient's walking, bending, or daily activities. On the contrary, because the pain is gone, our patients move more flexibly and comfortably.
After Spondylolisthesis Surgery, Can the Screws Bend, Break, or Come Loose?
If the bone fusion is achieved in a healthy way, the load on the screws is removed. However, if there is a delay in fusion due to excess weight, uncontrolled movements, or smoking, screw loosening or breakage may rarely occur. This situation is usually related to the patient not following instructions.
Do the Screws Placed During Spondylolisthesis Surgery Have a Service Life; Will They Need to Be Replaced in the Future?
No, these screws do not have an expiration date. Once bone fusion is achieved, they can remain in the body for life and do not need to be removed unless they cause a problem.
After Spondylolisthesis Surgery, Will the Vertebrae Below the Screwed Level Deteriorate Over Time (Adjacent Segment Disease)?
Fixing one level can somewhat increase the load placed on the adjacent levels. This is called "Adjacent Segment Disease". However, with the correct surgical technique and regular post-operative exercise, this risk can be minimized.
After Spondylolisthesis Surgery, Will These Metal Plates Set Off the Security Gates at Airports and Shopping Malls?
No. Modern titanium plates usually do not trigger sensitive security gates. In very rare cases where they do beep, a surgery card or report obtained from your doctor will be sufficient to explain the situation.
After Screw Surgery for Spondylolisthesis, When Will My Sex Life Return to Normal?
It can generally return to normal gradually about 4-6 weeks after surgery, once tissue healing has been achieved and your doctor gives approval.
If I Plan to Get Pregnant After Spondylolisthesis Surgery, Will the Screws in My Back Be an Obstacle?
No, the screws in the back do not pose an obstacle to becoming pregnant or to childbirth. However, it is more suitable for the mother's health if the bone fusion is completed before pregnancy (usually 1 year after surgery).
How Long Is Wearing a Corset Mandatory After Spondylolisthesis Surgery?
In order to support the stabilization of the bone and the screws, wearing a corset is generally recommended for the first 4 to 6 weeks. Afterwards, the corset is gradually discontinued in order to strengthen the muscles.
After Spondylolisthesis Surgery, When Does Fusion (Bone Union) Occur, and How Do We Know?
Bone fusion is a biological process, and its complete occurrence takes between 6 months and 1 year. This is monitored through periodically taken X-rays and CT scans, by the formation of new bone bridges between the vertebrae.
