Retrolisthesis

Retrolisthesis involves an alignment problem in the spine.  A spinal vertebra moves back in relation to the one next to it.  This can be diagnosed on imaging studies of the spine. Retrolisthesis can cause back pain and result in pressure on nerves.  Treatment may be medical and in severe cases surgical.

What is Retrolisthesis?

Retrolisthesis is when one vertebra moves backward in relation to the one below or above it.  We say there is retrolisthesis of L2 on L3. That means that the second lumbar vertebra has moved backward in relation to the third lumbar vertebra.

Retrolisthesis grading

The severity of retrolisthesis is graded from 1 to 4.  Grade 1 movement involves less than 25% of the vertebra.  Grade 2 involves 26-50% movement of the vertebra.  Grade 3 involves 51-75% movement of the vertebra.  Grade 4 involves greater than 76% of the vertebra.

Retrolisthesis vs spondylolisthesis

Retrolisthesis means that a vertebra in the spine has moved backward.  Spondylolisthesis means that a vertebra has moved in relation to the ones next to it.   Spondylolisthesis does not specify the direction of movement of the vertebra in relation to the one next to it.

What causes retrolisthesis?

There are many causes of retrolisthesis.

Trauma or broken vertebra can cause movement of the vertebra in relation to the one next to it.

Getting older and the associated degenerative change can cause movement of the vertebra.  This occurs as the cartilage between the vertebra thins.

Arthritis of the spine can cause the vertebra to move.

Spinal masses can also cause one vertebra to move in relation to another.

Symptoms of retrolisthesis

The symptoms will depend on the degree of retrolisthesis and what part of the spine is involved.  There can be a pinched nerve.  Patients may have pain, spasms, weakness, tingling, and difficulty walking.

How is retrolisthesis diagnosed?

retrolisthesis is diagnosed on imaging studies of the spine like X-ray, CT and MRI.  We will see one vertebra that is moved back in relation to the one next to it.  The severity of movement of the vertebra will also be determined.

Studies like CT and MRI will also help with identifying a cause.  We can see fractures, tumors, arthritis, and other conditions of the spine which may contribute to retrolisthesis.

What does retrolidthesis look like on imaging?

Imaging will often show one of the vertebra of the spine to not be in alignment with the other vertebra. Retrolisthesis  will mean that one or multiple vertebra are slipped backward.

Retrolisthesis on CT scan

CT scan will allow us to look at the alignment of the spine and see any vertebra out of alignment. retrolidthesis will be seen as one vertebra moved backward in relation to the one next to it.  CT will also allow us to see any fractures or other abnormalities which may be contributing to the retrolisthesis.

Retrolisthesis on X-ray

Xray will also show us the alignment of the spine, best on the lateral view.  This is an X-ray taken from the side of the patient.  We will see a shift backwards of one of the vertebra in relation to the one next to it.

Retrolisthesis on MRI

MRI will also show us retrolisthesis.  This will best be seen on the sagittal sequences.  These section the spine from side to side.  An advantage of MRI is that we will see detail of all the surrounding structures which can be contributing to retrolisthesis.

Is retrolisthesis dangerous?

Usually not.  In severe cases there can be difficulty walking and loss of bladder function.

Is retrolisthesis degenerative?

One of the most common causes of retrolisthesis is getting old and degenerative arthritis.

What type of doctor treats retrolisthesis?

Non surgical treatment of retrolisthesis can involve primary or specialty care.  Surgical treatment will be by a spine surgeon.

Retrolisthesis treatment

Mild cases can be treated with pain medications, physical therapy, and excersises to strengthen the spine.

Surgical therapy is reserved for more severe cases.  This involves removing bone to relieve pressure on bones and nerves (decompression surgery).  Fusion involves stabilizing the spine.  The procedures may be combined to treat retrolisthesis.

Retrolisthesis: summary

Retrolisthesis is an alignment problem of the spine.  One of the vertebra moves backwards in relation to the one next to it.  This can cause pressure on nerves and pain.

Retrolisthesis is diagnosed on imaging studies like X-ray, CT, and MRI.  The severity is graded on a scale of 1 to 4.  Treatment of mild cases may involve medications and physical therapy.  More severe cases may involve surgical therapy.