This disease in the spine refers to the following, when looking at the spine from the side, the vertebrae are stacked and aligned on top of each other following the natural curves of the spine (kyphosis and lordosis) which allows it to be more efficient when standing and walking. Spondylolisthesis is when one vertebra is misaligned with respect to the others and is displaced forward with respect to the vertebra immediately below. Most cases are generated in adulthood by the natural wear and tear of the disc.

• Degenerative spondylolisthesis is more common in people over 40 years of age.
• Degenerative spondylolisthesis is more common in women than in men.
• Dysplastic spondylolisthesis (vertebral deformity) is more common in children and adolescents.

There are 5 categories of spondylolisthesis according to the cause of the disease:

• Degenerative (natural wear and tear of the disc and the facets that allow displacement).
• Isthmic (When the bone at the back of the vertebrae that joins the vertebrae is broken).
• Post-traumatic or post-accident.
• Congenital are born with deformity "dysplasia" in the last 2 vertebrae of the lumbar spine, this deformity allows the displacement of one over the other.
• Generalized bone pathology that degenerates and destroys the posterior elements (e.g. rheumatoid arthritis).

There are other less common types of scoliosis that may accompany the following problems:

• Cerebral palsy or muscular dystrophy.
• Defects in the formation of the vertebral bodies during pregnancy
• Thoracic surgery in patients under 10 years of age   
• Infections of the disc and/or vertebra.
• Vertebral tumors
• Spinal cord anomalies such as spina bifida occulta, myelomeningocele.
• Secondary to a genetic syndrome such as neurofibromatosis, mucopolysaccharides, arthrogryposis, VACTER, among others.

• Low back pain.
• Pain with changes in position.
• Pain, cramps and numbness in the legs.
• Weakness in the legs.
• Increased back and leg pain during walking

• • Difficult to manage sciatic leg pain
  • Paraparesis or chronic leg weakness.
  • Atrophy of the leg muscles.
  • Weakness and severe limitation in walking. 
  • Limitation to flex the trunk.
  • Alteration in sphincter control.

Most spondylolisthesis in initial stages generate mild symptoms that are self-limiting and improve with analgesics, generally causing low back pain and occasional leg cramps; as the disease progresses, back pain increases and leg cramps become more frequent and intense. In the advanced or severe stages of the disease it generates constant back pain, inability to walk, altered sphincter control and leg cramps that are difficult to manage.
The assessment should be performed at any stage of the disease, this does not mean that surgery is required, a gradual management is performed starting with physical therapy, analgesics, spinal blocks, and in advanced stages or when the symptoms are not controlled with the previously mentioned treatment, surgery is performed.
Let me assess the type and degree of your spondylolisthesis to guide you in the best management of this disease.