Spondylolisthesis is classified according to cause, direction of vertebral slippage, and severity:

1. By cause:
   • Dysplastic spondylolisthesis: Congenital malformation of the vertebral bodies or vertebral arch.
   • Isthmic spondylolisthesis: Due to a defect or fatigue in the area of the vertebral arch (spondylolysis).
   • Degenerative spondylolisthesis: Wear-related vertebral slippage, mostly in older people.
   • Traumatic spondylolisthesis: Triggered by fractures or injuries.
   • Pathological spondylolisthesis: Result of diseases such as tumors or infections.
2. By direction:
   • Anterolisthesis: The vertebra slips forward.
   • Retrolisthesis: The vertebra slips backward.
3. By severity (Meyerding classification):
   • Grade I: Up to 25% displacement.
   • Grade II: 26–50% displacement.
   • Grade III: 51–75% displacement.
   • Grade IV: Over 75% displacement.

The causes vary depending on the form and risk factors:

- Mechanical stress:

- Repeated stress on the spine, especially from sports such as weightlifting, gymnastics, or football.

- Incorrect posture or overload in everyday life.

- Degenerative changes:

- Wear and tear of the intervertebral discs and vertebral joints with age.

- Loosening of the ligaments and instability of the spine.

- Congenital factors:

- Malformations or weaknesses in the area of the vertebral bodies and arches.

- Injuries:

- Fractures or trauma that affect the stability of the spine.

- Other risk factors:

- Overweight, genetic predisposition, or systemic diseases.

The symptoms depend on the severity and the affected region:

• Back pain:
  • Dull, deep-seated pain, often after physical exertion.
• Movement restrictions:
  • Limited flexibility of the spine, especially when bending forward or stretching.
• Neurological symptoms:
  • Pain, tingling, or numbness radiating into the legs or arms.
  • Weakness in the lower extremities due to pressure on the nerve roots.
• Postural changes:
  • Increased hollow back or visible asymmetry in the back.
• Fatigue and muscle tension: Often due to improper loading of the back muscles.

The diagnosis is made through a combination of medical history, clinical examination, and imaging techniques:

- **Medical History:**

- Collection of symptoms, previous illnesses, and stressful activities.

- **Physical Examination:**

- Visual inspection for postural abnormalities and changes in posture.

- Tests for spinal mobility and neurological function assessment.

- **Imaging:**

- **X-ray:** Standard method for confirming displacement and measuring severity.

- **MRI:** Visualization of soft tissues, nerve roots, and intervertebral discs.

- **CT:** Detailed assessment of bony changes or fractures.

Conservative Therapy

Most cases, especially those with low severity, can be treated conservatively:

• Physiotherapy:
  • Exercises to strengthen the back muscles and improve stability.
  • Posture training to reduce incorrect loading.
• Medication Therapy:
  • NSAIDs: To relieve pain and inflammation.
  • Muscle relaxants for tension.
  • X-ray guided injections of corticosteroids for pain therapy in acute complaints.
• Orthopedic Aids:
  • Use of corsets or braces to stabilize the spine.
• Pain Management:
  • Heat or cold therapy to relax the muscles.

Surgical Therapy

In severe cases or persistent complaints despite conservative measures, surgery becomes necessary:

• Decompression: Removal of tissue that exerts pressure on nerves.
• Spondylodesis (Spinal Fusion):
  • Fixation of unstable vertebrae using screws, plates, or implants.
• Correction of Displacement: Restoration of the natural spinal alignment.
• Minimally Invasive Procedures: Gentle techniques with shorter recovery time.

The following measures are suitable for preventing spondylolisthesis and supporting its treatment:

1. Back training: Regular exercises to strengthen the back muscles and stabilize the spine.
2. Ergonomic posture: Avoidance of incorrect loading in everyday life and work.
3. Weight control: Reduction of spinal load through a healthy weight.
4. Avoidance of overload: Limitation of heavy physical activities or loads.
5. Early detection: Regular check-ups for back complaints or family predisposition.