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.
What is Retrolisthesis?
Retrolisthesis is a medical condition characterized by the posterior (backward) displacement of a vertebral body in relation to the one below it. In simpler terms, it refers to the backward shifting of one vertebra on another in the spine.
Retrolisthesis is a form of spondylolisthesis, which is the slipping of one vertebra over another, but specifically refers to the backward displacement of the vertebra. Anterolisthesis, on the other hand, is when there is forward slippage.
Retrolisthesis can occur in any part of the spine but is most commonly seen in the lumbar (lower back) region. The severity of retrolisthesis is determined by the amount of displacement of the vertebra, with grades ranging from 1 to 4, based on the percentage of displacement. Radiopaedia includes xray cases of retrolisthesis here.
Types and Causes of Retrolisthesis
There are several types of retrolisthesis, often classified by their underlying cause:
Degenerative retrolisthesis is the most common cause, and is due to general wear and tear on the spine. Overtime, the bones and ligaments which hold the spine together may become weak and unstable.
Isthmic retrolisthesis is the result of another condition, called “spondylosis”. Spondylosis refers to a fracture of a small bone, called the pars interarticularis, which connects the facet joint of the vertebra to the one below. If this interconnecting bone is broken, it can lead to slippage of the vertebra. This can sometimes occur during childhood or adolescence but go unnoticed until adulthood when degenerative changes cause worsening slippage.
Congenital retrolisthesis occurs when the bones do not form correctly during fetal development
Retrolisthesis can also occur due to a traumatic injury to the spine, such as a fall, car accident, or sports injury.
Pathologic retrolisthesis is when other disorders weaken the points of attachment in the spine. This includes osteoporosis, tumors, or infection that affect the bones and ligaments causing them to slip.
Iatrogenic retrolisthesis is the result of a prior surgery. Some operations of the spine, such as a laminectomy, may lead to instability. This can cause the vertebra to slip post operatively.
Symptoms of Retrolisthesis
The symptoms of retrolisthesis can vary depending on the degree of displacement and the location of the affected vertebra. Some people with retrolisthesis may not experience any symptoms, while others may have severe symptoms. Common symptoms of retrolisthesis include:
- Lower back pain: This is the most common symptom of retrolisthesis, especially in the lumbar spine. The pain may be dull or sharp and may worsen with standing or walking.
- Numbness or tingling: retrolisthesis can compress the nerves in the spinal column, causing numbness, tingling, or a pins-and-needles sensation in the legs.
- Weakness: retrolisthesis can compress nerves and weaken the muscles in the legs, making it difficult to walk, stand, or climb stairs.
- Stiffness: retrolisthesis can cause stiffness in the lower back, making it difficult to move or bend.
- Loss of bladder or bowel control: In severe cases of retrolisthesis, the compression of the spinal cord can cause loss of bladder or bowel control. This may be a sign of cauda equina syndrome, a neurological emergency, and you should seek medical attention immediately.
It’s important to seek medical attention if you experience any of these symptoms, as untreated retrolisthesis can lead to complications and long term pain and nerve damage.
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.
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 of Retrolisthesis
For those experiencing pain, oral medications are first line treatments. This includes non-steroidal anti-inflammatory medications (NSAIDs) such as ibuprofen, acetaminophen, or in severe cases opioids or muscle relaxants (with extreme caution). Topical medications such as lidocaine patches are also sometimes used.
Physical therapy can help improve mobility and strengthen muscles around your spine to stabilize your neck and lower back. You may also receive stretching exercises to improve flexibility and balance exercises to improve coordination.
Surgery is reserved for severe cases of spondylolisthesis in which there is a high degree of instability and symptoms of nerve compression.
In these cases a spinal fusion may be necessary. This surgery joins two or more vertebra together using rods and screws, in order to improve stability.
Wang, Yi Xiang J et al. “Lumbar degenerative spondylolisthesis epidemiology: A systematic review with a focus on gender-specific and age-specific prevalence.” Journal of orthopaedic translationvol. 11 39-52. 1 Dec. 2016, doi:10.1016/j.jot.2016.11.001
He, Da et al. “Prevalence of Lumbar Spondylolisthesis in Middle-Aged People in Beijing Community.” Orthopaedic surgery vol. 13,1 (2021): 202-206. doi:10.1111/os.12871