L4-L5 Spondylolisthesis

The L4-L5 segment is the most flexible part of the lumbar spine. Though this flexibility is crucial to carry out basic movements, it also makes the L4-L5 more susceptible to certain spinal conditions, including spondylolisthesis

Table of Contents

  • What is Spondylolisthesis at L4 L5?
  • What Are The Symptoms of L4-L5 Nerve Damage?
  • Can L4 and L5 Spondylolisthesis Cause Hip Pain?
  • Can You Be Paralyzed From Spondylolisthesis?
  • Can I Go To The Gym With Spondylolisthesis?
  • What Are The Treatment Options for L4-L5 Spondylolisthesis?
  • In this article, we’ll go over the most common questions about L4-L5 spondylolisthesis and explain the treatment options available for this prevalent spinal condition. 

    What is Spondylolisthesis at L4 L5?

    L4-L5 spondylolisthesis is most often caused by spinal degeneration. With age, the spinal structures naturally weaken and break down. This can compromise the stability of the spine and trigger the vertebral slippage associated with lumbar spondylolisthesis. 

    Spondylolisthesis develops when a vertebra slips out of its normal position and settles on the vertebra beneath it. This occurs as a result of spinal instability. 

    L4 and L5 are the lowest lumbar vertebrae. The lumbar (lower) spine is the most susceptible to injury because it’s particularly flexible and bears more impact than the upper or middle spine. With this in mind, the L4-L5 segment is the second most common area for spondylolisthesis (L5-S1 is the most common segment). 

    What Are The Symptoms of L4-L5 Nerve Damage?

    L4-L5 nerve damage can cause symptoms including:

    • Sharp pain that starts in the lumbar spine and travels down the leg
    • Numbness in the lower extremities, including the leg, foot, or toes
    • Weakness in the leg when you move
    • Tingling or a pins-and-needles feeling that travels from the lower back down the leg

    Nerve pain that moves from the lumbar spine to the buttocks and down the back of a leg is generally labeled sciatica. The sciatic nerve runs from the lower back to the hips and buttocks, then down each leg. 

    Various factors can cause sciatica flare-ups, including stress, excess weight, wearing unsupportive shoes, and poor posture. If you experience sciatica symptoms with L4-L5 spondylolisthesis, you’ll benefit from stress management, weight management, wearing supportive shoes, and practicing good posture to avoid flare-ups. 

    Can L4 and L5 Spondylolisthesis Cause Hip Pain?

    Damage to L4 and L5, including spondylolisthesis, can lead to hip pain. This is because the misaligned vertebrae can press on nerves that extend through the hips. When these nerves become irritated, inflamed, or damaged, the patient may experience significant hip and leg pain. 

    Can You Be Paralyzed From Spondylolisthesis?

    Spondylolisthesis can cause paralysis if it’s left untreated for an extended period. Specifically, without the proper treatment, spondylolisthesis can cause serious nerve damage, which can lead to paralysis. 

    Cauda equina syndrome is a possible complication of L4-L5 spondylolisthesis that presents a high risk of paralysis. The cauda equina is a group of nerves and nerve roots at the lumbar end of the spinal cord. Cauda equina syndrome develops when nerve roots in the cauda equina become compressed, presenting a risk of bowel and/or bladder dysfunction, as well as paralysis. 

    To prevent permanent nerve damage and disability, it’s essential to seek out immediate medical care for cauda equina syndrome. Warning signs to look out for include:

    • Saddle anesthesia, which is numbness and lost sensation in the buttocks, inner thighs, and the perineum
    • Weakness and periodic changes in sensation (i.e. numbness) in the lower limbs
    • Bowel and/or bladder dysfunction
    • Unexplained sexual dysfunction
    • Referred pain (pain felt at an area of the body other than its origin)
    • Impaired tendon reflexes 

    Can I Go To The Gym With Spondylolisthesis?

    Most patients can go to the gym with spondylolisthesis, but it’s important to avoid exercises that may strain the spine. Additionally, you should check with your doctor before exercising if you’ve been diagnosed with spondylolisthesis. 

    Exercises that are typically safe to perform at the gym with spondylolisthesis include:

    • Walking on the treadmill
    • Using the elliptical machine
    • Completing gentle strengthening exercises, including pelvic tilts and curl-ups
    • Gently stretching
    • Doing yoga (while omitting positions that strain the spine)

    Exercises to avoid at the gym if you’ve been diagnosed with spondylolisthesis include:

    • Running on the treadmill
    • Weightlifting
    • Using the back extension machine
    • Box jumps
    • Jumping rope
    • HIIT workouts

    What Are The Treatment Options for L4-L5 Spondylolisthesis?

    A broad array of treatment options is available for L4-L5 spondylolisthesis, including:

    Physical Therapy

    Physical therapy is widely regarded as one of the most effective non-invasive treatments for L4-L5 spondylolisthesis. The goal of PT for spondylolisthesis is to strengthen the muscles that protect the spine, promote mobility, and prevent further injury.  

    Your physical therapist may recommend both passive and active treatments for spondylolisthesis. Passive treatments, like massage, heat/cold therapy, and electrostimulation therapy, help alleviate muscle tension and promote healing. 

    Active physical therapy methods typically include targeted exercises recommended specifically for your needs. 

    Pain Medication

    Certain medications can help with the symptoms of lumbar spondylolisthesis:

    • NSAIDs
    • Neuropathic agents
    • Muscle relaxants
    • Corticosteroids

    Lifestyle Adjustments

    Making specific lifestyle adjustments can help you recover from L4-L5 spondylolisthesis:

    • Avoiding high-impact exercise and activities that may strain the spine
    • Quitting smoking and using nicotine products, which reduce the flow of blood, oxygen, and nutrients throughout the body
    • Practicing good posture, which reduces unnecessary strain on the spinal structures
    • Getting plenty of sleep each night so that your body has a chance to rest and recover 


    Since spondylolisthesis involves spinal instability, wearing a brace can help prevent pain and neurological symptoms. The brace will help keep your spine in the proper alignment and can help heal a fracture in the pars interarticularis. 

    Spinal Surgery

    Although most cases of spondylolisthesis can be resolved with conservative treatments, surgery may be required in severe cases. Generally, physicians don’t recommend spondylolisthesis surgery unless the patient has undergone six to 12 months of conservative therapies and still experiences chronic, debilitating symptoms. 

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    Spinal fusion is the most commonly done procedure for spondylolisthesis. This operation involves fusing the affected vertebrae with bone graft material. In the weeks and months after the procedure, the vertebrae will become a single bone. 

    For spondylolisthesis patients, spinal fusion can permanently correct the slippage of the vertebra. Unfortunately, it also limits mobility and poses the risk of future degeneration in the adjacent spinal segments. 

    Alternatives to spinal fusion like the TOPS System can help spondylolisthesis overcome their symptoms without losing spinal mobility. The TOPS System is a non-fusion mechanical device implant that stabilizes the affected vertebrae and recreates the natural motion of the spine. Additionally, it’s designed specifically to be used at a single level between L2 and L5. 

    To learn more about the available treatments of L4-L5 spondylolisthesis, contact a medical provider in your area today.