Spondylolisthesis occurs when one vertebra slips forward over the one below it. This slippage can compress nerve roots, cause spinal instability, and produce back pain and leg symptoms. It ranges from mild (Grade I) to severe (Grades III–IV), with surgical treatment typically reserved for patients who fail conservative care.
What are the symptoms?
- Persistent low back pain, often worsened by standing or walking
- Leg pain, numbness, or weakness (from nerve root compression at the slip level)
- Pain that is relieved by sitting or lying down and worsened by activity
- Tight hamstrings and a changed walking gait in higher-grade cases
- Neurogenic claudication — leg pain that comes on with walking and is relieved by rest
- Visible step-off deformity at the lumbosacral junction in severe cases
What causes it?
- Degenerative spondylolisthesis: The most common type — caused by facet joint arthritis that allows the vertebra to shift forward; typically at L4–L5
- Isthmic spondylolisthesis: A stress fracture (spondylolysis) through the pars interarticularis of the vertebra allows slippage; often at L5–S1 and may present in young athletes
- Traumatic spondylolisthesis: Acute fracture following injury
- Iatrogenic: Can develop after prior spinal surgery due to loss of ligamentous support
How is it diagnosed?
Standing lateral X-rays confirm the degree of slip and allow calculation of slip percentage and angle. Flexion-extension X-rays assess mobility at the slip level. MRI reveals nerve compression and disc degeneration at the affected level. CT scans provide additional bony detail for surgical planning.
Your Non-Surgical Roadmap — Surgery Is the Last Step
Most patients with this condition get better without surgery. Here's the path Dr. Chavarria follows before an operation is ever on the table:
- 1
Start conservative
Physical therapy, activity changes, anti-inflammatory or nerve medication, and time — the first line for nearly every spine condition.
- 2
Add targeted relief
If symptoms persist, image-guided injections (epidural or nerve blocks) can calm inflammation and pinpoint the source of pain — often avoiding surgery entirely.
- 3
Re-evaluate together
Dr. Chavarria reviews your progress and imaging with you, honestly, and explains exactly where you stand — no pressure, no rush to the OR.
- 4
Surgery — only if it's truly the best option
Reserved for severe or worsening nerve compression, instability, or when conservative care has had a fair chance. When it is right, you'll understand why and what to expect.
Treatment Options in Reno, NV — Conservative Care First
Conservative treatment — including physical therapy focused on core stabilization, activity modification, and epidural injections — is the first-line approach for most patients. When slippage progresses, causes neurological deficits, or fails to respond to conservative measures, Dr. Chavarria performs minimally invasive lumbar fusion (MIS-TLIF) to stabilize the spine at the slip level, correct alignment, and decompress the compressed nerves. This approach achieves the same correction as traditional open surgery with smaller incisions and faster recovery.
Treatment Procedures
Lumbar Spinal Fusion (TLIF/PLIF)
Lumbar spinal fusion permanently connects two or more vertebrae together, eliminating painful motion at an unstable or severely degenerated spinal segment. Techniques such as TLIF (Transforaminal Lumbar Interbody Fusion) and PLIF (Posterior Lumbar Interbody Fusion) restore disc height, decompress the nerve, and stabilize the spine — and can be performed with minimally invasive techniques through small incisions.
Learn More →Minimally Invasive Spine Surgery
Minimally invasive spine surgery uses specialized instruments and a small incision — often less than an inch — to treat many spine conditions with less muscle disruption than traditional open surgery. Most patients go home the same day and return to daily activities in weeks rather than months.
Learn More →Laminectomy & Decompression
Laminectomy is a decompression procedure that removes the back portion of a vertebra (the lamina) to enlarge the spinal canal and relieve pressure on the spinal cord or nerve roots caused by spinal stenosis. It is the most commonly performed surgery for lumbar spinal stenosis and offers excellent results in restoring the ability to walk and stand without leg pain.
Learn More →