Anterolisthesis – Medical term, Causes, Grade 1 to 4, Treatment with Images

Anterolisthesis - Medical term, Causes, Grade 1 to 4, Treatment with Images
Image Credit: Dr. James Heilman, MD

What is Anterolisthesis?

Anterolisthesis is a condition that affects spine and in which the body of upper vertebrae, the area in front of every vertebrae which is drum-shaped, slips forward onto the body of the vertebra that stands below and moves it out of its original position. When this condition occurs, this causes pressure on a spinal cord or spinal nerves, causing further pain and other symptoms.

The quantity of slippage is graded on a scale from 1 to 4, from mild to severe, and the treatment can be from bed rest to surgery.

First Grade is 1, which is mild and represents less than 25% slippage, while grade 4 is severe and represents slippage bigger than 75% slippage.

The symptoms that appear in anterolisthesis can seriously vary, depending if and in which amount the slippage pinches the nerve roots and which area of spine is affected. Synonim for anterolisthesis is spondylolisthesis.

This condition usually affects lower back, but, debilitating consequences can affect other parts of the body, such as arms and legs.

What is Anterolisthesis - Grading 1, Treatment, Causes, Symptoms
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Anterolisthesis usually occurs among elderly, because aging is common cause for anterolisthesis, and it is something that happens naturally over the time because cartilage between vertebrae body becomes thinner and weakens during the time which provides vertebrae slippage out of its position.

Anterolisthesis often happens because of sudden blunt force trauma or fractures. Anterolisthesis is usually the result of trauma which is typically experienced in a car accident or a fall. Anterolisthesis can also develop over time through tiring physical exercise, for example, bodybuilding.

how does anterolisthesis happen
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Tumors are also linked with the appearance of anterolisthetsis. A tumor affects on a vertebrae in a way that moves a body of vertebrae from its natural position.

Another common disease of the joints, which can also affect the spine and can cause anterolisthesis is arthritis.

From time to time, it can also be linked to a genetic spinal growth defect that even can affect children.


To understand how a person can develop anterolisthesis, most important is first to explain the anatomy of the spine in which this condition is developed. The main role in this condition has vertebrae, which are piled up along back and form the spine. They have hole at the center and that provides room for the spinal cord which goes through the spinal canal, which includes all the nerves of the human body. When it comes to structure, the vertebrae are wider at the top and bottom side of its body, while they are narrower around the middle, which has the role to enhance stability when they are piled up on top of each other.

Regardless of its need to remain stable, vertebrae of human body still move on top of each other because of the layer of cartilage which is compound between every two vertebrae. These small movements that happen, allow human body to bend and twist effectively.

But, from time to time, one vertebra can slip too far from its natural limits, backward or forward. When the upper vertebrae slips forward, this condition is the condition that we refer to as anterolisthesis. The opposite thing, when vertebra slips backward is referred to as retrolisthesis.

In this unnatural position, the canal of spinal cord is narrowed and depending on the amount of slippage, it can cause abstemious to severe compression of the spinal cord. With the affection of the spinal cord, since exiting nerves branch go out from in between the vertebrae bodies to different parts of the body, they can also have problems. These nerves, also, can become compressed because of the abnormal position and lead to symptoms beyond the back.


The symptoms that occur in anterolisthesis depend on the amount of slippage and the part of the spine in which the slippage occurred.

Anterolisthesis can cause permanent and severe pain which is localized, or it can develop and becomes worse over the time. Pain may be persistent and often can affect the lower back, legs, or upper back and arms.

Pain is usually the first sign and it is caused by the compression of the nerves. Pain can be around the area of the lower back, middle or even in the neck area, which depends oo the location of the slip. If the slippage compresses spinal nerve, there will be certain amount of pain in the area that this nerve innervates.

Another issue that can cause more problems is mobility issue, which occurs because of the pain and can further lead to inactivity and weight gain. Second problem that is connected with this one is loss of bone density and muscle strength. Flexibility in other areas of the body can also be affected.

Other symptoms that can develop in anterolisthesis are spasms of the muscles, pulsating or tingling sensations in soft tissues of back and limbs, persons inability to feel hot or cold sensations, pain and poor body posture and weakness. In some more serious cases, due to affection of the nerves that serve the abdomen person can develop loss of bladder or bowel function or difficulties in walking and limited body movement, because of the problems in nerves that provide signals for motion.


The first step in diagnosing the artherolsthesis involves a study and evaluation of the symptoms which are experienced by the person, but there are many conditions that can lead to similar symptoms, so the doctor which is giving diagnose needs to be careful.

The diagnosis also has to involve a physical examination, in which the doctor will try to locate the source of the pain and check for any other visible causes. One of the things that the doctor will check is checking the reflexes.

If the doctor believes the symptoms are indicative to anterolisthesis, imaging technology should be used to take a look at the structure of a patients spine. The most commonly used technology are X-rays, and they are very effective for bone defects and they provide a picture of the vertebrae. Further images which can be provided by magnetic resonance imaging (MRI) and CT scans will inform the doctor about the level of nerve damage based on the extent of vertebrae slippage.


Grading of anterolisthesis is the next step that comes after giving a diagnosis and it serves to establish the extent of the damage. The grading scale is used to determine the severity of the condition and what treatment is required. These are the scales values-

Grade 1– which represents less than 25 percent of slippage
Grade 2– which represents slippage from 26 to 50 percent
Grade 3– which represents slippage from 51 to 75 percent
Grade 4– which represents slippage of 76 percent or more

There are some very rare cases of 100 percent slippage, and that happens when upper vertebra slips completely off from one in the below.

What is anterolisthesis grade 1,2,3,4?
What is anterolisthesis grade 1,2,3,4?


The doctor will recommend the treatment which will be based on grade of vertebrae slippage.
Due to the spinal cords great flexibility, most patients that suffer from grades 1 and 2 of anterolisthesis will not experience any major symptoms, only alleviate pain and discomfort and in this case only conservative treatment options will be used. Treatment options for this mild slippage that can be reversed simply by resting and by avoiding tiring activities, will include bed rest, gentle exercise and pain medication. This way of treating is especially helpful when the patient is young individual whose body can still heal on its own very quickly. The thing that also can help in this way of treating of 1st and 2nd grade of anterolisthesis is wearing a back brace for additional support and using a orthopedic pillows while sleeping for supporting the spine.

Another thing that can also be very helpful if patient is suffering from pain is prescribing pain relievers.
Again, the type of medications that will be prescribed depends of the symptoms, where people with mild symptoms will receive mild pain relievers and strong pain symptoms receive the strongest pain killers. Most of the mild pain relievers are non steroidal anti inflammatory drugs, such as ibuprofen and aspirin and steroids for treating any sort of inflammation. Serious symptoms may need opiods which are, narcotics but they are very effective. Most often, non steroidal anti inflammatory drugs are prescribed as the first treatment, but if the symptoms still persist, then opiods are given, but it is very important to be very careful because they tend to create addiction, which can leave more problems after treating the original problem.

Another way of treating problems is physical therapy .This measure is palliative and it does not address to the vertebrae itself. Physical therapy helps to strengthen back muscles which helps to support spine and also reduces pain by enabling releasing of endorphin.

Grade 3 and 4 of slippages are considered severe and can ultimately require chiropractic therapy or surgery. Chiropractor has a job to attempt to manipulate the vertebrae back into the position through the massage and it is procedure that often works. Surgery is considered a last option and it is reserved for the most severe cases where patient experience great symptoms. One of the option for the surgery is to reduce nerve compression by realigning the vertebrae, and the second way is stabilizing the spine by using internal fixation. Procedures that can follow are using metal rods, screws, plates or wires to keep the spine in good position.

The most important thing that person should do after a surgery are the proper exercises, to keep the muscles strong. Here are six exercise which are indicated in this situation:

Pelvic tilt which is should be performed by laying on back with the knees bent and feet flat against the floor. Belly button then is pulled toward the spine by using abdominal muscles and focus should be on pressing the low back flat against the floor. Hold in this position for 10-15 second.

Dead bug which is advanced version of pelvic tilt. Position is the same, belly button brought to the spine, and, while keeping the legs bent, one of them is lifted off from the floor and hold like that for 5 seconds, and the changing the legs. Next, one arm should be lifted over the head and hold for 5 second. It should be repeated with other arm.

Partial curl, the exercise in which the position is the same as in the first exercise, and then the chin is tuck to the chest and the upper body is curled forward and the shoulders are lifted off the floor with the hands straight out in front. This position should be held for three seconds.

Gluteal stretch, in which position is lying on a back with both knees bent, and then the ankle of one leg should be against the knee of the other leg. Then, the tie of the bottom leg should be grab and pulled toward the chest until stretch feeling in buttocks. This pose should be kept for 15-30 second.

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