Retrolisthesis: What Is Backward Vertebral Slippage and Should You Be Concerned?
Retrolisthesis is a condition in which one vertebra slips backward compared with the one below it. It most often affects the lower back or the neck. It can narrow the spaces where nerves leave the spine. Symptoms range from stiffness in one area to pain that spreads. Standing imaging often shows slippage that lying-down scans underestimate.
Key points
- Retrolisthesis means a vertebra has moved backward out of its normal position.
- It is graded by how far the bone has moved, from mild (grade 1) to more significant.
- Lying-down scans can hide how far the bone has really slipped, because gravity and body weight are taken away.
- Standing, weight-bearing imaging shows your spine as it works in daily life.
- If you develop numbness, weakness in your legs, or loss of bladder or bowel control, get urgent medical help from your doctor or the nearest emergency department.
Your spine is made of separate bones (vertebrae) stacked on top of each other. Normally they line up neatly in a gentle curve. With retrolisthesis, one of these bones slides backward, even by a small amount. That shift can narrow the channel your spinal cord runs through. It can also squeeze the openings where nerves branch out to the rest of your body.
The condition is often found on an X-ray or scan done for back or neck pain. Your report may say "grade 1 retrolisthesis". This simply means the slippage is at the milder end of the scale. Higher grades mean more movement. The grade helps clinicians decide how best to manage it.
What are the symptoms of retrolisthesis?
The most common symptom is a dull, aching pain where the bone has slipped, often in the lower back or neck. Some people also have stiffness, limited movement, or pain that travels into the buttocks, legs or arms. This depends on which part of the spine is affected.
Not everyone with retrolisthesis has symptoms. Some people only find out when they are scanned for another reason. How bad the symptoms are does not always match the grade of the slip. This is why a full picture of your alignment matters.
What causes retrolisthesis?
Retrolisthesis develops when the structures that hold a vertebra in place lose strength or get damaged. The most common cause is disc degeneration. Here the cushion between two vertebrae thins over time, which lets the bone above slide backward.
Changes that come with age are the most frequent cause. But retrolisthesis can also follow surgery at a nearby level of the spine, or develop alongside other conditions such as scoliosis. Understanding the root cause helps shape how it is managed.
What is the difference between retrolisthesis and spondylolisthesis?
The key difference is direction. In retrolisthesis the vertebra slips backward, while in spondylolisthesis it slips forward. In both, one bone moves out of line with the one next to it, and both can press on nerves. Spondylolisthesis is talked about more, but retrolisthesis is not rare and can cause similar symptoms.
Both conditions are best assessed with the spine upright and under load. When you lie down for a standard scan, gravity is taken away and your muscles relax. A slip that causes problems while you are standing or walking may look less significant on a lying-down image, or may not show at all.
How does standing imaging help assess retrolisthesis?
Standing, weight-bearing imaging captures your spine exactly as it works in everyday life, with gravity pulling on it and your muscles actively supporting it. This shows the true position of each vertebra under load. That is critical for a condition defined by movement between bones.
EOS is a low-dose imaging system that scans your whole body while you stand. It uses about 90% less radiation than a standard X-ray, around ten times less. It captures your full skeleton from head to feet in one image. So your clinician can see how a slip at one level of the spine relates to the alignment of your pelvis, hips and legs below.
Your body is a connected chain. A backward slip in the lower back changes the curve of your spine. This can tilt your pelvis, shift your weight, and put strain on your hips or knees. It works the other way too: a problem lower down, such as one leg being longer than the other, can contribute to retrolisthesis higher up. Whole-body standing imaging shows these links in a way that lying-down scans of a single area simply cannot.
Want to see how your spine is aligned in real everyday conditions?
Book a free video consultationWhat can be done about retrolisthesis?
Management depends on how severe it is and on the symptoms. Mild cases are often managed without surgery, with physiotherapy to strengthen the muscles that steady the spine, especially the deep core and back extensors. Changing activities and being aware of posture also play an important role.
More significant cases, or cases with symptoms, may need input from a spine specialist. They might recommend targeted injections or, in some situations, surgery. The first step in any plan is an accurate picture of what is happening. Your clinician needs to know the grade and direction of the slip, whether nearby levels are affected, and how the rest of the skeleton has adapted. All of this helps them choose the right approach.
Before you start treatment, or change the one you are on, it is worth getting a detailed diagnosis. Whether the cause sits in the pelvis, the legs or the spine changes what will actually help.
When is MRI more suitable? EOS is excellent at showing bone position, joint alignment and the overall balance of your skeleton. If your clinician suspects a disc herniation, nerve compression or other soft-tissue problems alongside retrolisthesis, MRI is usually the better tool for those specific questions. The two scans work well together.
Frequently asked questions about retrolisthesis
It depends on the grade and on whether it is pressing on nerves. Many people have mild retrolisthesis with few or no symptoms. If you develop numbness, weakness in your legs, or loss of bladder or bowel control, get urgent medical help from your doctor or the nearest emergency department.
Grade 1 means the vertebra has slipped backward by a fairly small amount. It is the mildest grade and is often found by chance on a scan. Many people with grade 1 retrolisthesis manage it successfully with strengthening exercises and regular check-ups.
It can, especially if the underlying cause (such as disc degeneration or joint wear) progresses. Regular assessment helps track any change. Strengthening the muscles around the spine can slow progression.
Core stabilisation, pelvic tilts and controlled extension exercises are commonly recommended. A physiotherapist can design a programme for your level of slip and your symptoms. Accurate imaging beforehand helps them target the right area.
Retrolisthesis is about the position of the bone. A herniated disc is about the soft cushion between the bones bulging or rupturing. They can happen together, and both can press on nerves. But they need different types of imaging to assess properly.
When you lie flat, gravity no longer pulls on your spine and your muscles relax. The slipped vertebra can settle back closer to its normal position. This makes the slip look smaller, or even invisible. Standing imaging shows the slip under real everyday load.
Yes. EOS uses about 90% less radiation than a standard X-ray, around ten times less. You can find more about safety and what to expect on our FAQs page.
No. ScanAlign accepts self-referrals. You can book a free video consultation directly and discuss whether an EOS scan is suitable for you.
For patients travelling from abroad, the price is confirmed during the free video consultation, and you can read more on our FAQs and cost page.
Yes. A backward slip changes how your spine curves. This can change the tilt of your pelvis and shift weight unevenly through your hips and knees. This is why whole-body imaging is valuable. You can learn more about how hip alignment connects to the spine.
Understand your spine in real everyday conditions
A free video consultation lets you talk through your symptoms from home and find out whether standing, whole-body imaging at our London clinic is right for you. No referral needed.
Book a free video consultationWritten by Abbas Dhami (Specialist Diagnostic Radiographer)
Sources
- NHS. "Back pain." nhs.uk, accessed 2024.
- Shen M, Razi A, Engquist D. "Retrolisthesis and lumbar disc herniation: a preoperative assessment of patient function." The Spine Journal, 2007;7(4):406–413.
- American Academy of Orthopaedic Surgeons (AAOS). "Spondylolisthesis." orthoinfo.aaos.org, accessed 2024.
Learn more about how standing spine imaging shows alignment problems, or read the full EOS scan overview.
This page is general information and not a diagnosis.
ScanAlign is the trading name of CoreMed Solutions Ltd and operates under The Harley Street Hospital's CQC licence.