Retrolisthesis is a backward slippage of one vertebra over the one below it. Unlike the more commonly discussed forward slippage (called anterolisthesis or spondylolisthesis), retrolisthesis involves a vertebra shifting toward the back of your body. It’s typically diagnosed when a vertebra has slipped backward by 3 millimeters or more, which corresponds to roughly 8% displacement relative to the vertebra beneath it.
How Retrolisthesis Differs From Spondylolisthesis
The term “spondylolisthesis” is an umbrella word for any vertebral slippage. Within that category, the direction of the slip matters. Anterolisthesis means a vertebra slides forward, which is far more common. Retrolisthesis means it slides backward. Both conditions can compress nerves and cause pain, but research on cervical spine patients found that with a similar degree of displacement, forward slippage tends to have a greater impact on spinal cord compression than backward slippage does. That said, retrolisthesis is not harmless, and for years it was underestimated. It was historically treated as an incidental finding on imaging, something doctors noticed but didn’t consider clinically significant. That view has shifted as more evidence links it to pain and reduced function.
What Causes It
Retrolisthesis develops when the structures holding your vertebrae in place weaken or deteriorate. The most common underlying factor is degenerative disc disease. As the discs between your vertebrae lose height and moisture with age, there’s less cushioning to keep each vertebra locked in position. The joints, ligaments, and muscles that normally stabilize the spine can no longer compensate, and a vertebra gradually drifts backward.
Other contributors include spinal injuries, poor posture sustained over years, osteoporosis (which weakens the bone itself), and excess body weight that places chronic stress on the spine. The lower back is the most commonly affected area, particularly the L5 vertebra where it sits on top of the sacrum, though retrolisthesis can also occur in the cervical (neck) region.
Grading the Severity
Doctors grade vertebral slippage using the Meyerding classification, which measures how far the vertebra has moved as a percentage of the one below it:
- Grade I: 0% to 25% displacement. This is the most common finding and often the least symptomatic.
- Grade II: 25% to 50% displacement.
- Grade III: 50% to 75% displacement.
- Grade IV: 75% to 100% displacement.
- Grade V: Greater than 100%, meaning the vertebra has completely fallen off the one below it (called spondyloptosis, which is extremely rare).
Most retrolisthesis cases fall into Grade I. Higher grades are uncommon but carry a much greater risk of nerve damage and spinal instability.
How It’s Diagnosed
Retrolisthesis is identified on a standing lateral X-ray of the spine. You need to be upright for the image because gravity and body weight influence how the vertebrae sit relative to each other. A lying-down X-ray can miss the slippage entirely. The radiologist measures the distance between the back edges of two adjacent vertebrae. A backward shift of more than 3 millimeters qualifies as retrolisthesis. MRI is often used alongside X-rays to check whether the slippage is compressing nearby nerves or the spinal cord, and to evaluate the condition of the discs.
Symptoms to Recognize
Mild retrolisthesis may cause no symptoms at all. When it does produce symptoms, they typically include localized back or neck pain (depending on where the slip occurs), stiffness, and reduced range of motion. You might notice the pain worsens with certain movements or after standing for long periods.
If the displaced vertebra presses on a spinal nerve root, it can cause radiculopathy: pain, numbness, tingling, or weakness that radiates into your arms or legs. In the lower back, this often mimics sciatica, with symptoms traveling down through your hip, buttock, and leg. In the neck, it can radiate into the shoulders and hands. In rare and severe cases, compression of a bundle of nerves at the base of the spine can cause numbness in the groin area or loss of bladder and bowel control. This is a medical emergency called cauda equina syndrome.
Conservative Treatment
Most retrolisthesis is managed without surgery. The primary goal is to stabilize the affected segment of the spine by strengthening the muscles that support it. Exercise is the cornerstone of treatment, with a specific focus on deep core muscles. The transversus abdominis (the deepest layer of your abdominal wall), the obliques, the lumbar multifidus (small muscles that run along the spine), and the quadratus lumborum (which connects your ribs to your pelvis) are all targets. One of the most important exercises is the “drawing in” maneuver, a technique where you gently pull your belly button toward your spine to activate those deep stabilizers. A physical therapist can guide you through the progression.
Beyond exercise, treatment often includes improving posture during daily activities, weight reduction to decrease spinal load, and sometimes wearing a brace or corset for temporary support. Pain relief may involve microcurrent therapy or other modalities. Nutritional factors also play a role in tissue repair, since healthy discs and bones depend on adequate calcium, vitamin D, and protein intake.
When Surgery Becomes Necessary
Surgery is reserved for cases where conservative treatment has failed and the symptoms are severe enough to interfere with daily life. Specific triggers include progressive neurological deficits (worsening numbness, weakness, or loss of coordination), spinal instability that doesn’t respond to physical therapy, and pain so severe that walking independently becomes difficult. The most common surgical approach is spinal fusion, which permanently joins the slipped vertebra to the one below it using hardware and bone graft. This eliminates the abnormal movement but also eliminates normal movement at that segment, which is why it’s considered a last resort.
Recovery from spinal fusion typically takes several months, with restrictions on bending, lifting, and twisting during the healing period. Most people return to normal activities within three to six months, though full bone fusion can take up to a year.