For appointments or confidential discussion call
London Clinic 07776 511824
Norwich Clinic 01603 505063

The London Norwich Spine Clinic is based at
Hospital of St Johns & St Elizabeth, St Johns Wood, London
and the Spire Norwich Hospital, Norwich.

Information for GPs

Your spine is one of the most important and complex parts of your body - keeping it healthy is vital if you want to lead an active and pain free life.


When the spinal bones move out of their proper alignment and one vertebra slips forward or backward onto another vertebra below.

The slip usually occurs between the fifth bone in the lower back and the first bone in the sacrum (pelvis) area but can be sometime be between the fourth and fifth lumbar vertebrae.

It is categorized into five grades of severity according to the degree of slip.


  • Birth defect of weakness in that area of the spine
  • Traumatic fractures from sudden injury
  • Stress fractures - These are common in teenage athletes (especially gymnasts, weight lifters and footballers) due to stress on bones in the lower back caused by repeatedly overstretching the spine.
  • Degenerative disease (such as arthritis)
  • Bone diseases


The severity and type of symptoms depend on the grade of the condition but can include:

  • General pain across the lower back (that may feel like muscle strain)
  • Tenderness in the affected area
  • Muscles spasms and stiffness, especially tightness in the hamstrings
  • Pain that radiates down into the buttocks and legs
  • Change in gait and posture
  • Numbness, tingling, weakness and sciatica (from pressure on nerve roots)

The condition can produce increased lordosis (also called a swayback posture, where the lower back over-arches), or kyphosis (roundback) as the upper spine falls off the lower spine.


  • A physical examination - raising a straight leg may be uncomfortable or painful, for example an X-ray will show if a vertebra is out of place and if there are any fractures
  • A CT scan or MRI scan may be needed before treatment if the nerves are affected

Treatment options

This varies depending on the severity of the condition but initial treatment is usually conservative.


  • Anti-inflammatory medicines to reduce back pain
  • Wearing a stiff back brace
  • Physical therapy strengthening and stretching exercises
  • Modifying activity - e.g. avoiding overstretching the back and playing contact sports until symptoms go away (in most cases, you can resume activities slowly)

Conservative therapy for mild spondylolisthesis is successful in about 80% of cases.


If pain does not get better with conservative treatment, the slip is severe or there are any neurological changes, then an operation may be needed.

Spinal fusion

This procedure is performed between the lumbar vertebra and the sacrum. Sometimes, an internal brace of screws and rods is also used to hold together the vertebra as the fusion heals.

Surgery leads to satisfactory results in 85-90% of people with severe, painful spondylolisthesis.

"My heartfelt thanks go out to Mr Rai for his care and expertise, without which I would not be enjoying life as I do now." Read case studies >

Case studies

Mr M, aged 66

Condition: Spondylolisthesis

Treatment: Spinal decompression with instrumentation

The patient's experience

"I developed a severe pain in by back and left leg. The pain became so great that I was forced to give up playing golf and bowls. I could barely walk 100 yards and was considering other methods of mobility. An x-ray on my lower spine identified the problem as spodylolisthesis.

During my consultation, Mr Rai clearly explained to me what needed to be done to correct the problem and answered all my questions.

Much to my amazement there was no pain after the operation and within weeks, following physiotherapy to help strengthen my muscles, I was already getting back into a normal routine.

One year on, I'm playing a full round of golf, back on the bowling green and walking several miles without discomfort.

My heartfelt thanks go out to Mr Rai for his care and expertise, without which I would not be enjoying life as I do now."