How Serious Is Retrolisthesis? Types, Grades, & Treatment

Retrolisthesis is a very rare joint dysfunction in which a spinal vertebra slips backward over the one below it. Your vertebrae is a series of small circular bones with multiple projections that allow the spinal cord to pass through it. When one of these bones slips or is displaced, it leads to spinal misalignment.

Retrolisthesis is often confused with spondylolisthesis, and both are referred to as vertebral displacement. While both conditions involve vertebral slippage, however, they differ in the direction of slippage: 

• Retrolisthesis involves backward vertebral slippage
• Spondylolisthesis involves forward vertebral slippage

Retrolisthesis is classified into three types based on the position of the vertebra compared to the adjacent vertebra:

1. Complete retrolisthesis: One vertebra shifts backward compared to the positioning of both vertebra above and below.
2. Partial retrolisthesis: One vertebra shifts backward to a spinal segment compared to the positioning of either vertebra above or below.
3. Stair-stepped retrolisthesis: One vertebra shifts backward compared to the positioning of the vertebra above, but moves ahead of the one below.

Retrolisthesis has four grades based on the percentage of the backward displacement of the intervertebral foramina. The grades help determine the instability of the adjacent joint as well.

• Grade I: 25%
• Grade II: 25%-50%
• Grade III: 50%-75%
• Grade IV: 75%-100%

Factors that cause retrolisthesis include:

• Birth defects
• Arthritis
• Spinal injury
• Stress and traumatic fractures
• Degenerative spinal diseases, such as degenerative disc disease
• Nutritional deficiencies, such as calcium and vitamin D deficiency
• Infections of the bone
• Weakened core muscles that are unable keep the back stable

The range of symptoms of retrolisthesis depends on the grade of retrolisthesis, effect on the surrounding structures, and overall health. Symptoms may include:

• Back pain
• Discomfort in one area of the back
• Limited range of motion
• Bulge in the spine
• Weakness of the abdomen muscles
• Numbness, weakness, or tingling around the displacement, which may spread to other regions of the body:
  • Arms
  • Shoulders
  • Hips
  • Buttocks
  • Legs

Your doctor will analyze your medical history and perform a physical examination to assess:

• Pain in the lower back and legs
• Loss of sensation in the legs and feet
• Structural and functional changes in the joints
• Arthritis

If the doctor suspects retrolisthesis after physical examination, lateral X-ray and magnetic resonance imaging scans of the spine may be ordered to confirm a diagnosis and determine the extent of displacement.

1. Nonsurgical treatment

Options may include:

• Nonsteroidal anti-inflammatory medicines (NSAIDs) to treat back pain and reduce swelling
• Muscle relaxants to relax the muscles
• Hot compress applied to the afflicted area
• Microcurrent therapy, which uses low-level electric currents to reduce swelling, pain, and inflammation
• Massages to increase circulation and muscular tone

2. Surgical treatment

Surgery is done as a last resort when all the other nonsurgical methods fail. The main aim of the surgery is to:

• Decrease pain
• Reduce slippage
• Treat instability
• Prevent or restore neurological damage

3. Physical therapy

Exercises and physical therapy are suggested to:

• Improve mobility
• Improve flexibility
• Gain strength to all the muscles and bone
• Alleviate back and leg pain
• Learn new ways to eat, sit, or move

4. Lifestyle modifications

Eating a nutritious, balanced diet may help improve the health of bones and joints. Diet can also help promote weight loss and reduce pressure on the vertebrae.

To reduce your risk of developing retrolisthesis, maintain good posture, exercise regularly, and develop healthy eating habits.