Retrolisthesis Differs From Spondylolisthesis

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The spinal disorder retrolisthesis is the opposite of spondylolisthesis. While both conditions involve a vertebral body slipping over the one beneath, the difference is directional. Retrolisthesis is a posterior or backward slippage, and spondylolisthesis (sometimes called anterolisthesis) is an anterior or forward slip. Another term for either disorder is vertebral displacement. Of the two, retrolisthesis is not common.
Retrolisthese C3 wikipedia.jpgGrade 1 retrolistheses, C3-C4, C4-C5. By James Heilman, MD - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=18848823Both disorders can develop at any vertebral level in the spinal column, although the cervical (neck) and lumbar (low back) regions are more common. The neck is subjected to stresses as it supports the head at rest and during different movements. Whereas, the lumbar spine bears the body’s weight, and absorbs and distributes forces while at rest and during physical function.

A retrolisthesis may involve the spine’s vertebra, discs, ligaments, tendons (fascia), muscles, and nerves. It may cause symptoms related to other spinal disorders, such as spinal stenosis, facet joint dysfunction, cauda equina syndrome (lumbar spine), and intervertebral disc bulge or herniation.

3 Types of Retrolisthesis

  1. Complete retrolisthesis: A vertebra slips backward between the spinal segment above and below it.
  2. Partial retrolisthesis: A vertebra slips backward to either the spinal segment above or below it.
  3. Stair-stepped retrolisthesis: A vertebra slips backward to the spinal segment above it and ahead of the one below it.

Retrolisthesis Grades of Severity
Similar to spondylolisthesis, the severity of a retrolisthesis is graded from 1 to 4 based on the percentage of posterior (backward) displacement of the vertebral body’s foramen (neuroforamen). The grade of a retrolisthesis is important to assessing the stability of the adjacent facet joint.

  • Grade 1: Up to 25%
  • Grade 2: 25% to 50%
  • Grade 3: 50% to 75%
  • Grade 4: 75% to 100%

Symptoms of Retrolisthesis
Retrolisthesis symptoms vary greatly and depend, in part, on the grade of vertebral displacement and how the adjacent structures are affected by the backward slippage.

  • Pain in the region of the vertebral displacement—intensity, frequency and description are varied (eg, dull, sharp)
  • The displacement may be palpable (felt by hand)
  • Range of motion (movement) reduced
  • Neurological symptoms—such as weakness, numbness, or tingling sensations at the site of displacement and/or radiate into other parts of the body (eg, shoulders, arms, buttocks, hips, legs)

Causes of Retrolisthesis
There are different spine-related problems that can cause or contribute to the develop of retrolisthesis. The partial list below are disorders that can affect the spine’s structures—that being, the individual anatomical parts (eg, bones, ligaments) that help maintain the spine's stability and normal function.

  • Degenerative spinal disorders (eg, degenerative disc disease)
  • Arthritis (eg, spondylosis, osteoarthritis)
  • Osteoporosis
  • Spinal injury (eg, spinal cord injury, fracture)
  • Muscle weakness in the abdomen and/or spine
  • Infections of the blood (eg, multiple myeloma)
  • Osteomyelitis (bone infection)
  • Birth defects
  • Nutritional deficiencies

Diagnosing Retrolisthesis
The diagnosis of retrolisthesis involves a physical examination and neurological evaluation that include details about your medical history and symptoms. Thereafter, standing x-ray imaging of your spine is performed (eg, anterior, posterior, lateral).

The retrolisthesis may be viewed on the x-ray or other imaging study. Using the image, your doctor can measure its displacement (how far out of normal position). If the displacement is more than 2 millimeters, your doctor may diagnose you with retrolisthesis (eg, Grade 1). Depending on the outcome of your neurological exam and review of symptoms, your doctor may order additional imaging tests, such as a CT or MRI scan.

Treatments for Retrolisthesis
If your doctor tells you that one of your vertebrae has slipped backward, you may immediately assume that spine surgery is your only option. There are many considerations before advancing to surgery, such as the retrolisthesis grade, stability of the slip and its risk for progression, symptom severity, and your response to non-operative therapies. Surgery is rarely needed.

Non-surgical treatments may involve a single therapy or a combination, and are often successful at managing the inflammation, pain and related symptoms.

  • Pain medication, such as non-steroidal anti-inflammatory drugs (NSAIDs), to reduce inflammation, ease pain
  • Muscle relaxant medication
  • Spinal injections
  • Ice, heat
  • Modification of physical activities that exacerbate pain and symptoms
  • Massage
  • Physical therapy; passive (eg, massage, ultrasound) and active (exercise) treatments
  • Walking, swimming, yoga (under doctor’s guidance)

If spine surgery is recommended, your doctor will explain exactly why it is necessary, the surgical goals and type of procedure. For example, a progressive or high grade retrolisthesis may require spinal stabilization using instrumentation and fusion to prevent the condition from worsening. As stated earlier, retrolisthesis can cause other problems, such as spinal stenosis that may require surgical decompression (eg, laminectomy) to relieve nerve impingement.

Your doctor may suggest nutritional support to improve and maintain your bone and joint health. Specific vitamins, such as vitamins A, C, and D, and nutrients like calcium and protein can be integral to long-term spine health.

The most important factor in preserving your quality of life with retrolisthesis is to follow your doctor’s guidance. Staying active, eating a healthy diet rich in nutrients, and taking care to prevent spinal injury go a long way toward helping to manage this condition.

Updated on: 04/04/18
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Physical Therapy for Spondylolisthesis
Stewart G. Eidelson, MD
SpineUniverse Founder, Orthopaedic Surgeon
Southpalm Ortho-Spine Institute
Boca Raton, FL
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