11/26/2025
Can you spot the problem area on this X-ray?
If you follow the vertebra you can find that L4 has shifted forward relative to L5.
I would classify this as a grade I spondylolisthesis, meaning the displacement is between 1-25% of the vertebral body.
This may appear daunting, but these segments can be stable. A motion series X-ray, when the patient is put in felexed and extended positions can help determine this.
If the degree of displacement changes with motion, we can determine that the segment is unstable.
Believe it or not, the spinal canal can be reduced by 50% before symptoms of myelopathy or stenosis present.
Typically these arise from old injuries to the pars interarticularis that later degenerate and gradually begin to shift.
They can also be related to a birth defect in which the laminate does not fully form, commonly known as spina bifida ‘oculta.’
To prevent further degeneration, that would mean taking stress off the joints and strengthening the levers that control this region.
We’ve all heard people talk about the importance of having a strong core and glutes, but did you know that can actually stabilize your spine?
Our body stabilizes itself against gravity all day long without us thinking about it. The bones create the framework, but what holds them together?
Our ligaments create passive stability around the joint, meaning they aren’t generating movement. They’re changing with the movement to support the structure in its place.
Our muscles create an active stability, meaning they’re moving the structure in an organized fashion.
When the muscles aren’t able to coordinate movement efficiently, or the degree of movement is too intense for the passive stabilizers to support… it damages the ligaments.
If this damage creates total tissue failure then the result is joint dislocation.
This isn’t as common though as microtraumas… these might occur thousands of times before your brain registers a ‘problem.’
The result here is the body tries to repair itself through a cascade of inflammatory processes, which harden the ligaments… sometimes fusing the joint.
This puts extra stress on the bone, because it subject to more tensile forces due to compensatory changes.
Eventually this can reach a failure point in which the bone begins to shift.
What’s crazy to me, is that the principles of recovery are the exact same before as they are after.
Activate key muscle groups to facilitate controlled movement through greater ranges of motion— that is mobility.
A mobile body is one that is less painful.
The sad part is that most people wait until something like this happens before they begin to make the changes.
However, if someone in this situation elects for surgery… they’re still going to have to make those changes eventually.
Truth be told, some people who make the changes before surgery sometimes end up not needing the surgery.
If you’re not willing to make the changes before though, will the surgery cure you of everything?
It breaks my heart, but this is why 30-40% of back surgeries fail.
