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Retrolisthesis / listhesis - exercise, lumbar belt or surgery?

kaifmahmoodkkaifmahmood Posts: 12
edited 06/11/2012 - 8:39 AM in Chronic Pain
Hi all,

I have been trying to find more information / experiences relating to listhesis but there doesn't seem to be much on the internet about that.

My back pain started two years ago. I was diagnosed with mild protrusions on L5 S1 and L4 L5. Over time, the pain has become sciatic and I have also developed Grade 1 Retrolisthesis at L4 L5. The pain only seems to be getting worse over time and I wonder if I have to go in for surgery. Currently I exercise my back for 30 minutes a day as the physiotherapist has told me and walk about an hour a day.

I wonder if any of you can say something about:

a) Experiences with retrolisthesis or spondylolisthesis

b) My doctor told me to wear a lumbar belt (some call it lumbar corsette) a few hours a day to set right the structure of my spine. But a friend of mine who is also a doctor (though not an orthopedic) said that this will weaken the muscles and make my pain worse in the long run (I am not sure if this will happen if I wear it only 2 hours a day). I don't know who to listen to.

c) Has anyone been in surgery for retrolisthesis and has it worked? Are there any other treatments like exercise?


Protrusions - L4-L5, L5-S1
Retrolisthesis - L4 L5


  • I had a grade 1 spondylolisthesis at L4-5 and I had a fusion to address the problem almost two years ago. I never was aware that I had any instability and my primary problem was horrendous sciatic-type pain, numbness in both feet, and loss of ankle reflex in right leg. I've never had any back pain.

    My PT who worked in a specialized clinic that mainly dealt with scoliosis patients, suggested I get a sacro-belt, which is the same as what you are referring to, I believe. I found it useful when I was doing more than my usual amount of walking. I don't think it is a problem to wear it for part of the day.

    Did you not have the retrolisthesis at the beginning when you first found out you had mild protrusions?

    If you don't have any major nerve compression, I would think you could wait to have surgery until you can't stand the pain any longer...unless there is too much instability.

    I guess I should add that as far as I know, there really isn't any alternate treatment for a listhesis....you either live with it or have surgery....Two years ago, the only possibility for me surgically was an instrumented fusion. Perhaps things have changed, but if so, I am not aware of it.

    You should have a flexion X-ray if you haven't done so yet.
  • thanks for the response gwennie. the first time the mild protrusions were detected in an mri the slippage of the vertebra was very little and it wasn't noticed by anyone.

    my doctor told me that the best thing to do is to build up my core back muscles so that i don't put too much pressure on the vertebra and worsen the retrolisthesis.

    it seems that it is difficult to say whether my pain in the back and legs is because of the disc protrusions or the retrolisthesis or both. I suppose that unlike protruding discs, one cannot expect the vertebra to go back.

    currently i wear my lumbar belt about 2 hours a day and it makes me feel really comfortable, while at most other times my discomfort ranges from very mild to quite a bit of pain. i don't have any instability as far as i can tell.

    i suppose i shuold watch and if the difficulties continue perhaps surgery can be considered. i am in the UK for till July-august next year and i want to get any major treatment only when i am back home in india. i go there this christmas for a couple of weeks and will meet the doc to discuss all this.

    what is the use of a flexion x-ray?

  • Extension X-ray is a regular X-ray procedure, but they put you in a position where you are standing with your back arching back...and then, flexion X-ray is a pose where you are bending forward at the waist. This is the best way to see if there is slippage of one vertebrae over another one.

    Yes you are right, all you can do is try to keep a slippage from becoming worse...and I'm not sure how much we can actually do to influence that! Sometimes a slippage does not cause any pain, and people don't even know they have the problem. It is only when a nerve is being compressed or there is noticeable instability that it becomes an issue.

    If I were you, I would do whatever you can to strengthen the soft tissue and avoid surgery for as long as you can. I was getting a transforaminal injection recently. The nurse in the procedure room, who had recently switched jobs from a hospital emergency room, innocently asked me if people ever had just ONE back surgery. She hadn't met any patients that fit that category. I assured her there must be some out there, but I did not know any personally!!

    Have a safe trip home and a happy holiday.

  • I had terrible low back pain for years and I did have a SI belt that a chiropracter had me wear for some time. I was told by some that I shouldn't wear it because it may weaken certain muscle.... It did relieve a lot of pain but it was hard to wear while doing any kind of work. I do have 3 different lumbar belts that I was wearing for certain physical activities before and after the surgery. I still use then on occation.

    My retro was pretty bad by the time I was diagnosed. Definately worse with movement. My NS explained it (even though the bulge was small in a neutral positions) the curving fwd/bending shoved the disc into the spinal canal. Also there was a decent amount of arthitis in my facet joint causing pain with movement.

    My flexion/extension films were done with me laying on a table. One was flexing backward as far as I could go and the other was curving forwards as far as I could curve. The only time my flex/ex views were standing was for my neck.

    I was told to build my core as well which is hard when your tail bone is hanging on by a thread and you are in a great deal of pain. My fusion made all the difference and is solid like a rock now. Core is much stronger than it has been in years.

  • ChampsCChamps Posts: 1
    edited 07/08/2013 - 4:08 AM
    Because of the posterior movement of the vertebrae I use various types of lumbar rolls. This helps to maintain the lumbar lordosis and to gently move the vertebrae forward. I use a lumbar roll while seated. As an added therapeutic measure I sometimes lie on my back with the roll in the appropriate location under me. It helps a lot.

    Another thing that helps me is reaching behind my back while walking. I locate the protruding bone and gently push forward and upward at about a 45 degree angle. Usually after a few steps the pain lessens.

    I try to avoid heavy lifting because that increases the retro bone and my back pain.

    When I do have to lift or pull excessively I do the following all at the same time at the moment of lifting:

    1. I take a deep abdominal breath and exhale through tight lips - like blowing out birthday candles (Deep Abdominal Breathing)
    2. Pull my belly button backwards- toward my spine. This activates the "Transverse Abdominal" muscle which helps to stabilize the lumbar spine. It acts like a built-in corset or back brace.

    I hope this helps you. I am sure all of us try things that help our individual situations. These are some of those things that help me.

    ** Warning **
    Before you start any exercise program, you need to discuss it with your doctor first to get their approval.
    What may sound like a simple and harmless exercise may be very helpful to him, but can be very dangerous to you or someone else
  • aptehomeaaptehome Posts: 1
    edited 09/24/2014 - 2:54 AM
    Just like what gwinnie17 wrote - I was never aware that I had any instability and my primary problem was horrendous sciatic-type pain, numbness in both feet, and loss of ankle reflex in right leg. I've never had any back pain. The epidural w/cortisone shot stopped the pain but not the numbness or weakness. MRI shows stenosis at L4-L5 level and X-ray shows L5 misaligned...guess technically that's grade 1 spondylolisthesis at L4-5.
    Dr's advising fusing L4-L5-S1 bones...any advise? especially from Gwinnie as her symptoms were similar to mine..
  • don't have surgery especially a fusion in the hope that it will cure your pain .it's likely that it won't as a fusion will only correct the spine making it more stable .if there are existing damaged nerves or you get your nerves damaged during surgery then you will be in pain for a very long time .I would suggest if you can still exercise for half an hour that you take any conservative suggestions that are offered to you .even low tech things like ice and heat helps and a decent TENS machine could help {don't fall for any other machine that says is dose ;;;miracles ..!! stick to a NORMAL TENS if you intend purchasing one .many TENS companies that have said that there particular device can cure this and that and ;;is a strong on pain as narcotics ; have been discredited .so don't fall for any sales hype .amazon or TMS healthcare sell good machines the Omron E range are good and easy to use .as I have said if you want a private chat please PM me
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