I was recently diagnosed with a condition called spondylolisthesis. Fortunately, the orthopedic surgeon I went to ordered CT scans. Otherwise the cause of my back pain might never have been figured out. The X-rays I had taken didn’t show anything. Does that happen very often?

With spondylolisthesis, there is a fracture in the bony ring along the back of the vertebra. If the bone separates at the fracture site, it’s called spondylolisthesis. The affected vertebra slips forward over the one below it. The result can be a narrowing of the spinal canal (opening where the spinal cord travels down the spine). As the spinal canal gets smaller, any pressure or pulling on the spinal cord or nerve roots can cause neurologic problems.

When making the diagnosis, CT imaging is a better diagnostic tool (more accurate, more reliable) than X-rays. With these conditions, the fracture can be missed on X-rays depending on the patient’s position (standing up or lying down. The effects of gravity and postural muscles can really make a difference on X-ray results.

Whether or not spondylolisthesis is really the cause of low back pain remains a topic for discussion. Studies have not proven a clear and conclusive link between the two. There are just as many people with spondylolisthesis who do not have back pain, as there are people with back pain who have spondylolisthesis.

It’s natural to make the assumption that low back pain in someone who has a spinal defect seen on X-ray or CT scan must be caused by that condition. But this just isn’t so. Surgeons, scientists, and others are studying this problem looking for ways to prevent spondylolisthesis and reduce back pain from any cause.