When Is Surgery Needed For Retrolisthesis?

You may need surgery for retrolisthesis if your symptoms do not improve after 6 to 12 months of conservative treatment. Surgery is also recommended if you have progressive neurological damage, severe instability, or significant pain that disrupts your daily life.

At Total Orthopedics & Sports Medicine, we review your medical history, imaging results, and current symptoms to understand your condition. After a detailed examination, our spine specialists guide you through appropriate surgical options and help you choose a treatment plan that supports your long-term spine health. Call us at 855-321-6784 to book your appointment.

When Do Doctors Recommend Surgery for Retrolisthesis?

Our minimally invasive spine surgeon, Dr. Georgiy Brusovanik, MD, recommends spinal surgery for retrolisthesis if you have numbness, weakness, or tingling sensations that worsen over time. He also recommends surgery if a flexion-extension X-ray shows excessive movement (e.g., >3 mm displacement or significant change in disc angle) at the affected level. In such cases, surgery helps relieve pressure on nerves, improve stability, and reduce ongoing pain that affects mobility.

Moreover, Dr. Georgiy Brusovanik, MD, usually recommends surgery in the following situations:

Severe Functional Limitation

Severe retrolisthesis pain can limit your ability to perform basic daily activities. As this pain increases, you may find it difficult to walk, sit, or sleep comfortably. In such situations, Dr. Georgiy Brusovanik, MD, may recommend disc replacement (Artificial Disc Replacement – ADR). During the procedure, he removed the damaged disc and replaced it with a mobile implant. This approach helps reduce neurogenic pain, restore spinal height, improve alignment, and maintain natural spinal movement.

Emergency Condition (Cauda Equina)

Acute cauda equina syndrome in retrolisthesis is a medical emergency requiring immediate surgical treatment. This condition occurs when severe nerve compression leads to loss of bladder or bowel control. Without timely retrolisthesis treatment, this condition can lead to nerve damage, paralysis, and permanent incontinence (loss of control over urine or stool). In such cases, urgent surgery helps relieve pressure and protect remaining nerve function. In fact, the American Association of Neurological Surgeons reports that surgery within 48 hours provides significant improvement. It helps improve sensory and motor function as well as bladder and bowel control.

Traumatic Retrolisthesis

According to NIH research, traumatic retrolisthesis can lead to disc extrusion (disc material pushing out) and nerve root injury. As a result, these injuries create severe instability and often require surgery for decompression and stabilization. For example, a 22-year-old patient developed lower limb weakness after an 8-meter fall due to L5/S1 retrolisthesis and acute disc extrusion. Spine surgeon for retrolisthesis performed decompression, corrected the alignment, and used instrumentation (surgical implants) to stabilize the spine. With early surgical treatment, the patient achieved full recovery and showed significant improvement in nerve function.

Significant Spinal Stenosis

Lumbar retrolisthesis can narrow the spinal canal and directly compress nearby nerves. Over time, it leads to intense leg pain, weakness, and numbness due to spinal cord compression. To relieve spinal pressure, Dr. Georgiy Brusovanik, MD, restores proper space for the nerves. He also improves spinal stability and prevents abnormal movement that could lead to deformity in the degenerative lumbar spine.

Who Is Most at Risk of Developing Retrolisthesis?

Older adults, especially those over 50, face a higher risk of retrolisthesis due to age-related degeneration that weakens spinal discs and ligaments. It is also more common in people with spinal conditions, such as osteoporosis, that reduce the stability of the lumbar spine. In some cases, a history of spine surgery can lead to lumbar retrolisthesis due to weakened bones and prior structural changes. Beyond that, the following risk factors can increase the risk of retrolisthesis:

Weak Core Muscles

Weak core muscles can directly lead to spinal instability and poor alignment. For instance, the core muscles (pelvic, back, and abdominal muscles) help maintain proper posture and control spinal movement. If these muscles lose strength, they fail to stabilize the spinal segment, placing extra stress on the discs and ligaments. Over time, this stress can cause instability and lead to the complete retrolisthesis (vertebra slipping backward).

Obesity

If you are overweight, you may face a higher risk of partial retrolisthesis because excess body weight places constant pressure on the spinal column and discs. As a result, this load increases stress on the lumbar spine, affects joint health, and disrupts normal alignment. This continuous pressure can also lead to spinal cord injury or degenerative disc disease, such as:

• Osteoarthritis: Joint surfaces break down and affect smooth spinal movement.
• Lumbar Spondylosis (spinal wear and tear): Structural changes in the spine reduce stability and increase strain on nearby segments.
• Spondylolisthesis (vertebra slips forward): NIH research reports that you face 66% higher risk of spondylolisthesis with increased BMI.
• Lumbar Disc Herniation: The disc protrudes and compresses nearby spinal nerves, which can cause pain and weakness.

Nutritional Deficiencies

Low levels of calcium and Vitamin D can weaken bones and reduce their ability to support the spine. Poor nutrition can also affect disc health, leading to retrolisthesis and reduced spinal support. Beyond that, a lack of essential nutrients slows down tissue repair and affects ligament strength. As a result, ligaments, discs, and muscles cannot properly support the vertebrae.

Infections

Infections can increase the risk of retrolisthesis (backward slippage of a vertebra). For example, blood or bone infections, such as osteomyelitis (bone infection), weaken the spine and affect its strength. This damage reduces the spine’s ability to maintain proper alignment and support surrounding structures. Over time, weakened bone and soft tissues fail to stabilize the vertebrae, leading to backward slippage.

Congenital Abnormalities

Congenital abnormalities can increase the risk of retrolisthesis in early childhood. In such cases, the condition may develop as a birth defect that affects the alignment of the lower spine. This often occurs between the sacrum (the triangular bone at the base of the spine) and the fifth lumbar vertebra. This misalignment reduces spinal support and can lead to backward slippage as the child grows.

Here are some common congenital abnormalities that affect spine stability:

• Spina Bifida: Incomplete development of the spinal bones, which can affect stability.
• Congenital Vertebral Malformation: Abnormal shape or formation of vertebrae that disrupts alignment.
• Transitional Vertebra: A vertebra that has features of two different spinal regions, which can affect movement and support.
• Facet Joint Abnormalities: Irregular joint structure that can disturb normal spinal motion.

Can Retrolisthesis Lead To Mobility Issues?

Yes, retrolisthesis can lead to significant movement limitations that affect your daily activities. This condition occurs when a vertebra moves backward out of its normal alignment, leading to instability and nerve compression. In such cases, you may experience stiffness and a reduced range of motion (limited ability to bend or twist).

In severe cases, radiating pain can affect coordination and increase the risk of falls. You may also notice muscle weakness due to nerve compression, which can affect your arm or leg strength. As these symptoms progress, your walking ability may reduce, and overall stability may decline.

How is Retrolisthesis Different from Spondylolisthesis?

Retrolisthesis involves the backward (posterior) displacement of a vertebra, while spondylolisthesis refers to the forward (anterior) slipping of the vertebra. Although both conditions affect spinal stability, spondylolisthesis occurs more commonly than retrolisthesis.

Moreover, spondylolisthesis often develops due to a structural defect in the bone (pars interarticularis fracture), especially in younger and active individuals. In contrast, retrolisthesis is often associated with degenerative changes, such as arthritis, disc thinning, and ligament laxity (loosened supporting tissues), which are more common in older adults.

How Do Doctors Determine The Severity Of Retrolisthesis?

Doctors assess the severity of retrolisthesis using lateral X-rays, MRIs, or CT scans, which confirm vertebral displacement (slippage) of more than 2 millimeters and show changes in alignment. In this process, they examine spinal stability, disc structure, and disc height to understand the level of degeneration in the affected area.

They also assess your pain levels, ADR candidacy, and nerve-related symptoms such as weakness or numbness. Then, they classify the condition into grades (Grade I to Grade IV) based on the degree of backward movement of a vertebra relative to the adjacent vertebra. For example, Grade I shows mild backward movement, while higher grades indicate severe instability.

Here is the grading system that classifies disc changes based on stability and severity:

• Grade 1 (0% to 25% displacement): Mild backward shift with minimal impact on stability.
• Grade 2 (25% to 50% displacement): Moderate displacement with significant instability in the spinal segment.
• Grade 3 (50% to 75% displacement): Significant backward movement that affects alignment and nerve function.
• Grade 4 (75% to 100% displacement): Severe displacement with high instability and increased risk of nerve compression.

Does Retrolisthesis Location Affect Surgery Decisions?

Yes, the location of retrolisthesis directly affects the choice of surgery. For example, if retrolisthesis occurs in the lower lumbar spine, especially at L4–S1, and causes instability, doctors may recommend a disc replacement or spinal fusion surgery to prevent further damage. In contrast, if the condition causes nerve compression without major instability, doctors may choose a procedure focused on relieving pressure. Moreover, this decision depends on the severity of symptoms, your medical history, and findings from a detailed physical examination.

What Are the Risks of ADR Surgery for Retrolisthesis?

After disc replacement surgery, you may face complications such as implant subsidence, migration, and heterotopic ossification (abnormal bone growth around the implant). You may also develop adjacent segment disease (degeneration in nearby discs), which can cause pain and reduce mobility. Beyond that, degenerative changes can increase the risk of dural tear, CSF leakage, and revision surgery for retrolisthesis.

Moreover, you may face the following complications that can affect your recovery after disc replacement surgery:

Infection

During disc replacement surgery, bacteria can enter the surgical site and increase the risk of infection. It is especially common in older adults because the immune response (your body’s ability to fight germs) slows with age. In such cases, the infection can spread and lead to conditions such as spondylodiscitis or an epidural abscess (a collection of pus around the spinal cord). You may also notice signs such as fever, chills, fatigue, or night sweats.

Dural Tear

A dural tear (small cut in the outer covering of the spinal cord) can occur during disc replacement surgery for retrolisthesis. Research published in the Cureus journal shows that this complication occurs in about 2.7% to 17.2% of cases. However, the risk of a dural tear varies based on surgical complexity, patient condition, and procedure-related factors.

Vascular or Soft Tissue Injury

During lumbar replacement surgery, the anterior approach can increase the risk of injury to nearby structures. This approach can affect major blood vessels, such as the iliac artery or vein, potentially leading to bleeding complications. Similarly, surrounding soft tissues such as muscles and ligaments can be damaged, leading to chronic disc injury, pain, and swelling.

Retrograde Ejaculation

Retrograde ejaculation is a common complication in men after disc replacement surgery for retrolisthesis. It often occurs when surgeons use an anterior approach (through the abdomen) to reach the affected disc. During this process, nearby nerves that control ejaculation may be affected. As a result, semen may enter the bladder instead of exiting normally, which can lead to infertility in men. In fact, a study on ResearchGate shows that retrograde ejaculation occurred in about 9.8% of patients who underwent disc replacement surgery at the L5–S1 level.

Can Retrolisthesis Return After Surgery?

Yes, retrolisthesis can return after surgery if the underlying cause is left untreated and degenerative changes persist. This can lead to weakened spinal support and disturbed alignment at the treated level. The vertebra also moves backward again at the same or a nearby segment. In some cases, surgical correction can shift load to the adjacent vertebra, potentially leading to further damage. Moreover, post-surgical changes can trigger recurrent symptoms of retrolisthesis, such as pain or reduced range of motion.

For example, a NIH case study reported a 71-year-old man who experienced severe leg pain and difficulty walking for 3 years before surgery. Imaging tests showed spinal stenosis (narrowing of the spinal canal) and degenerative slippage at multiple levels. After surgery, his symptoms improved at first, but he later developed back pain and a reduced range of motion within 3 months. Then, Follow-up scans revealed new retrolisthesis at a nearby level after initial treatment.

Over time, his symptoms worsened, and he could no longer walk independently. To prevent these complications, our spine specialists carefully review your symptoms, age, and overall spinal alignment before planning treatment. Based on these factors, we use specialized implants and select the most suitable surgical approach to improve stability and long-term outcomes. We also guide you with proper posture techniques and activity instructions to protect the spine during recovery. Contact us for advanced surgical treatment.

What is the Success Rate of LADR for Lumbar Retrolisthesis?

Lumbar Artificial Disc Replacement (LADR) relieves pain in about 75.9% to 87.5% of cases. In fact, a systematic review of Global Spine Journal involving 2,284 patients showed consistent improvement after LADR surgery. This study reported about 50.71% pain reduction (VAS) and 30.39% improvement in disability (ODI). After 8.3 years of follow-up, the average patient satisfaction was 86.34%. The studies also showed lower complication rates of 18.53% and reoperation rates of 13.6%. However, the outcome depends on the underlying condition, diagnostic accuracy, and precision of the implant.

Note: You should avoid lumbar total disc replacement (TDR) for retrolisthesis if you have osteoarthritis, severe facet joint degeneration, and sagittal imbalance.

Visit Total Orthopedics & Sports Medicine For Advanced Retrolisthesis Treatment Options!

If you have severe retrolisthesis, you may struggle with daily activities such as standing for long periods, bending, or maintaining balance. You may also notice persistent lower back pain, fatigue, disrupted sleep, or a tingling sensation radiating into your legs despite conservative care.

In such cases, our surgeon, Dr. Georgiy Brusovanik, at Total Orthopedics and Sports Medicine, develops surgical plans tailored to your spinal condition. During recovery, he also guides you through flexibility exercises, good posture, and lifestyle modification to improve muscle tone. Beyond that, we monitor your recovery with scheduled follow-up and adjust the treatment plan if needed. Call 855-321-6784 or visit 1111 Park Ave, #1, NY 10128 for lasting pain relief.

FAQs