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Spondylosis, Spondylolysis, and

Spondylolisthesis: What’s the
difference?

by Jeslin Thomas

It’s not as tricky as you may think. If you are curious or have been
diagnosed with one of these, the therapists at PT First can help you
out!

Spondylosis: refers to when you have degenerative osteoarthritis

(OA) of the spine- this essentially means that the space between
your vertebrae narrows as the protective cartilage that cushions
the ends of the vertebrae wears down with age. With time, you
may notice you have more of a flexed (forward bending) posture.
Individuals suffering from this may experience lower back pain, leg
pain, and/or numbness when standing or walking; symptoms may
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 only seem to improve with sitting or lying down1.

Spondylolysis: refers to a stress fracture defect in the pars

interarticularis of the vertebrae (commonly found in the L4/L5
region). This is usually caused by repetitive stress or trauma at the
Lumbar spine from strenuous activities involving excessive
twisting/rotating or back bending (ex: gymnastics, dancing,
wrestling, and football.). Symptoms may or may not be present
initially, but as the injury progresses, these individuals may
complain of pain as they bend backward or pain with general
activities2.

Spondylolisthesis: often refers to the progression of a spondylosis

injury, but it may also be congenital or idiopathic in nature.
Spondylolisthesis is defined as the displacement of one vertebra
over the vertebral body below it (commonly known as a “step off”
or “slip” at the L5/S1 level); individuals may even notice the
presence of a bump by the area of the slippage. There are 5
different grades of this slippage, and it’s defined by the extent to
which the vertebral body has slipped:
Grade I: O-25% Grade III: 50-75% Grade V: > 100%
Grade II: 25-50% Grade IV: 75-100%
Individuals with this may complain of localized pain that may come
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 and go with certain activities, and this may be the most notable
when bending backward or forward at the affected segment. They
may experience radicular pain down to one or both legs as the
vertebrae slides and causes compression of the nerve root below,
tense hamstrings, loss of bowel/bladder (rare), and difficulty with
balance or walking.

What can we do?

First, you can consult with your Doctor to obtain an MRI, CT, Bone
scan, or X-ray to confirm the diagnosis and determine the extent of
the injury. Treatments can involve both operative (surgical) or
nonoperative/conservative management (Physical Therapy,
NSAIDs/analgesics, and bracing). Generally, surgical interventions
are reserved for those with significant symptoms or failure of
conservative treatments.

With spondylosis, conservative management involving aerobic

exercises such as biking and general strengthening and stretching
of your whole body has been correlated to greater quality of life
among adults with lumbar osteoarthritis 3. In addition, maintaining
good posture throughout and maintaining our postural muscle
strength can help to decrease pain and promote proper muscle
length-tension relationships.
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 With spondylolysis, as with any fracture, your body will need time
to heal. This means 4-8 weeks (or longer) of rest from high impact
activities such as sports and lifting heavy items. Your Doctor may
also recommend pain medications such as NSAIDs or steroids to
help reduce pain and inflammation. During this time, Physical
Therapy may be recommended and can help with facilitating the
healing process, reduce pain, strengthen and stabilize specific
muscles, and help you navigate through your everyday activities.

In addition, with both spondylolysis and spondylolisthesis, studies

have shown that specific strengthening of the deep multifidus and
transversus abdominis can be beneficial for spinal instability that
commonly occurs 3,4. Overall, exercises to promote the full spinal
range of motion and lumbar strengthening exercises have been
proven to be a successful treatment option for decreasing pain and
functional limitations 2,4,5. At PT First, our therapists have treated
multiple patients with success when using this evidence-based
method. If you have any questions, don’t hesitate to ask any of our
licensed therapists!

References
Middleton, Kimberley, and David E. Fish. “Lumbar Spondylosis:
Clinical Presentation and Treatment Approaches.” Current
Reviews in Musculoskeletal Medicine 2, no. 2 (March 25, 2009):
94–104.

Garet M, Reiman MP, Mathers J, Sylvain J. Nonoperative treatment

in lumbar spondylolysis and spondylolisthesis: a systematic review.
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 Sports Health. 2013;5(3):225-232.
doi:10.1177/1941738113480936

VIEIRA, S., et al, Abdominal muscle strength is related to quality of

life among older adults with lumbar osteoarthritis. Journal of
bodywork and movement therapies, 2015. (level of evidence 2A)

Kalichman L, Hunter DJ. Diagnosis and conservative management

of degenerative lumbar spondylolisthesis. Eur Spine J.
2008;17(3):327-335. doi:10.1007/s00586-007-0543-3

Back Pain: Spondylosis, Spondylolysis, and Spondylolisthesis.

SPARCC Sports Medicine – Tucson AZ.
https://sparcctucson.com/2019/03/21/back-pain-spondylosis-
spondylolysis-and-spondylolisthesis/. Published October 23, 2019.
Accessed August 2, 2020.

Images:
https://www.braceability.com/blogs/articles/lumbar-
spondylolisthesis-vs-spondylolysis
www.youtube.com/watch?v=3SoNJ5ELR6Y
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