Summary
Anterolisthesis is a condition where a vertebra in the spine slips forward in relation to the vertebra below it. It is a type of spondylolisthesis, which refers to any abnormal forward or backward movement of one vertebra in relation to another.
Anterolisthesis can cause a variety of symptoms, including lower back pain, muscle weakness, numbness or tingling in the legs, and difficulty walking or standing for extended periods of time. Treatment options for anterolisthesis depend on the severity of the condition, but may include medication, physical therapy, or surgery.
What is Anterolisthesis?
Anterolisthesis is a medical condition characterized by the forward displacement of one vertebral body over the one below it. In other words, it is a form of spondylolisthesis, which is the slipping of one vertebra over another, but specifically refers to the forward displacement of the vertebra.
Anterolisthesis can occur in any part of the spine but is most commonly seen in the lumbar (lower back) region. The severity of anterolisthesis is determined by the amount of displacement of the vertebra, with grades ranging from 1 to 4, based on the percentage of displacement.
To learn more about the different grades of anterolisthesis and their impact on your health, click here
Radiopaedia includes some xray cases of anterolisthesis here.
Types and Causes of Anterolisthesis
There are several types of spondylolisthesis, often classified by their underlying cause:
Degenerative Anterolisthesis
Degenerative anterolisthesis 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 Anterolisthesis
Isthmic anterolisthesis 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 Anterolisthesis
Congenital anterolisthesis occurs when the bones do not form correctly during fetal development
Traumatic Anterolisthesis
Anterolisthesis can also occur due to a traumatic injury to the spine, such as a fall, car accident, or sports injury.
Pathologic Anterolisthesis
Pathologic anterolisthesis 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 Anterolisthesis
Iatrogenic anterolisthesis 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 Anterolisthesis
The symptoms of anterolisthesis can vary depending on the degree of displacement and the location of the affected vertebra. Some people with anterolisthesis may not experience any symptoms, while others may have severe symptoms. Common symptoms of anterolisthesis include:
- Lower back pain: This is the most common symptom of anterolisthesis, especially in the lumbar spine. The pain may be dull or sharp and may worsen with standing or walking.
- Numbness or tingling: Anterolisthesis can compress the nerves in the spinal column, causing numbness, tingling, or a pins-and-needles sensation in the legs.
- Weakness: Anterolisthesis can compress nerves and weaken the muscles in the legs, making it difficult to walk, stand, or climb stairs.
- Stiffness: Anterolisthesis can cause stiffness in the lower back, making it difficult to move or bend.
- Loss of bladder or bowel control: In severe cases of anterolisthesis, 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 anterolisthesis can lead to complications and long term pain and nerve damage.
You can learn more about the the different grades of anterolisthesis, their severity, and impact on your health here.
Prevalence of Anterolisthesis
Studies have found that anterolisthesis is more common in older adults and in women. The prevalence of anterolisthesis 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% with another study showing a prevalence of lumbar spondylolisthesis in up to 25.0% in women over the age of 60 (Wang 2016). According to HSS, anterolisthesis (forward slippage) is more common than retrolisthesis (backward slippage).
Anterolisthesis accounts for approximately 40% of cases of spondylolisthesis.
Diagnosing Anterolisthesis
Your doctor may order imaging tests to confirm the diagnosis and determine the severity of your spondylolisthesis. 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 Anterolisthesis
Medications
For those experiencing pain, oral medications are first line treatments for anterolisthesis. 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
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
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. MedFriendly describes more of the surgical treatment for anterolisthesis here.
For medical professionals, the ICD-10 reporting codes for spondylolisthesis start with M43.1 Spondylolisthesis, but a full list of anterolisthesis codes can be found here.
Sources
Bydon M, Alvi MA, Goyal A. Degenerative Lumbar Spondylolisthesis: Definition, Natural History, Conservative Management, and Surgical Treatment. Neurosurg Clin N Am. 2019;30(3):299-304.
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 translation vol. 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
Tenny S, Gillis CC. Spondylolisthesis. [Updated 2023 May 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-
