Spondylolisthesis Specialist · Naples & Fort Myers, FL
Spondylolisthesis. A vertebra out of position. Back pain, leg pain, walking limitation. Most patients don’t need fusion.
Spondylolisthesis means one vertebra has slipped forward on the one below it. It is one of the most common causes of back and leg pain — and one of the most over-fused. Dr. Katsevman offers TOPS motion-preserving surgery, minimally invasive laminectomy without fusion, and precision fusion only when genuinely needed.
"Most Grade I spondylolisthesis patients are told they need fusion. Many of them don’t. The question isn’t whether the vertebra has slipped — it’s whether it’s stable, and whether the symptoms come from instability or from nerve compression."
Dr. G. Katsevman, MD · Neurosurgeon & Spine Surgeon24% for fusion at 2 years
laminectomy or TOPS
invasive approaches
Right surgery, right patient
Understanding the condition
What is spondylolisthesis?
Spondylolisthesis (spon-dee-lo-lis-THEE-sis) occurs when one vertebra slips forward relative to the vertebra below it. The word comes from the Greek “spondylos” (vertebra) and “olisthesis” (slipping). The slip compresses the spinal canal and neural foramen at the affected level, causing back pain, leg pain, and in more severe cases the inability to walk significant distances without stopping.
The critical clinical question is not simply whether the vertebra has slipped — it is whether the spine is stable at that level, and whether the patient’s symptoms arise from nerve compression, instability, or both. This distinction determines which of the three surgical options is most appropriate.
Grading the slip
What grade is your spondylolisthesis?
Spondylolisthesis is graded by how far the vertebra has slipped — expressed as a percentage of the vertebral body width. The grade shapes the treatment conversation, but it is not the only factor. Stability, symptoms, and anatomy matter just as much.
The most frequently encountered spondylolisthesis. Many Grade I patients do not need fusion — when the slip is stable and symptoms are caused by nerve compression rather than instability, TOPS or decompression alone may be the right surgical answer.
More significant slippage with greater mechanical instability. Fusion is more commonly recommended at this grade, though the clinical picture and symptom pattern still guide surgical decision-making. Decompression alone is rarely sufficient.
Significant vertebral slippage causing major spinal canal narrowing and mechanical instability. Fusion is almost always required. Surgical planning involves careful EOS alignment analysis to ensure the correction restores adequate sagittal balance.
Extreme slippage with the vertebral body nearly or completely off the sacrum. Complex surgical planning is required. More commonly seen in younger patients with isthmic (congenital pars defect) spondylolisthesis than in degenerative disease.
Types of spondylolisthesis
Degenerative vs. isthmic — different causes, similar symptoms
The two most common types have different underlying mechanisms — and understanding which type you have affects the surgical approach.
Degenerative Spondylolisthesis
The most common type in adults — caused by disc degeneration, facet arthritis, and ligamentous laxity that progressively loses the ability to hold the vertebra in position. The pars interarticularis (bony bridge between the facets) is intact. Most frequently occurs at L4-5.
Key characteristic: The slip is usually Grade I or II and tends to be relatively stable mechanically, making non-fusion surgical options more frequently applicable.
Isthmic Spondylolisthesis
Caused by a stress fracture or defect in the pars interarticularis — the bony bridge that connects the facets. Without this structural connection, the vertebral body can slip forward. More common in athletes who perform repetitive hyperextension (gymnasts, football linemen, weightlifters). Most frequently at L5-S1.
Key characteristic: The pars defect creates true structural instability. Higher grades are more common in isthmic disease and fusion is more frequently required.
Recognizing your symptoms
What spondylolisthesis feels like
Spondylolisthesis symptoms overlap significantly with lumbar spinal stenosis — because the slipped vertebra narrows the canal at that level, compressing the same nerve roots. The key diagnostic distinction is made on MRI and dynamic X-rays.
Lower Back Pain
Aching, deep pain in the lower back — often worse with prolonged standing, walking, or extension (bending backward). The mechanical instability at the slipped segment is a direct pain generator, separate from any nerve compression. Patients often feel most comfortable sitting or slightly flexed.
Neurogenic Claudication
Leg pain, heaviness, or cramping that comes on with walking and is relieved by sitting or bending forward — the shopping cart sign. Caused by the canal narrowing at the slip level compressing the nerve roots. Often bilateral. This is the lumbar stenosis component of spondylolisthesis.
Sciatica
Shooting pain radiating down one or both legs into the buttock, thigh, calf, or foot. The slipped vertebra pinches the exiting nerve root in the narrowed foramen. When one-sided, it follows a dermatomal pattern corresponding to the compressed root level.
Leg Weakness or Numbness
Weakness in the legs, foot drop, or numbness in a dermatomal distribution — from nerve root compression at the slip level. Progressive weakness is an indication for more expedited evaluation, as prolonged compression increases the risk of permanent neurological deficit.
Step-Off Deformity
In higher-grade spondylolisthesis, a visible or palpable “step” may be felt in the lower back where the slipped vertebra creates an offset. The lumbar lordosis (lower back curve) may become exaggerated, and patients may develop a flexed posture and shortened stride.
Pain Improved by Sitting
Sitting flexes the lumbar spine, temporarily widening the stenotic canal and reducing the shear forces at the slip. Most spondylolisthesis patients report sitting as their most comfortable position and find relief leaning forward over a cart or counter — the same pattern as pure lumbar stenosis.
The question most surgeons don’t ask carefully enough
When a patient has spondylolisthesis and is recommended fusion, the implicit assumption is that the slip is unstable — that the vertebra is actively moving and causing symptoms through that motion. But many Grade I spondylolisthesis slips are stable: the vertebra slipped years ago and has not moved since. The patient’s symptoms come from nerve compression, not from the instability itself.
For a stable slip with neurogenic claudication, decompressing the nerves — without fusion — can relieve the symptoms completely. Adding fusion to a stable, non-progressive slip adds hardware, bone graft, a longer surgery, a longer recovery, and adjacent segment risk without meaningfully improving the outcome.
Dr. Katsevman evaluates stability using dynamic (flexion-extension) X-rays alongside the MRI. If the slip is stable, fusion is not automatically required. If it is unstable or high-grade, fusion is the right answer — and Dr. Katsevman performs it with EOS alignment planning and robotics and navigation to execute it precisely.
Treatment options
From conservative care to surgery
The treatment ladder for spondylolisthesis mirrors that of lumbar stenosis — conservative care and injections first, with surgery reserved for when they are insufficient. The surgical decision tree, however, has more branches.
Conservative non-surgical care
Physical therapy emphasizing core stabilization, lumbar flexion exercises, and postural strategies that reduce the mechanical load on the slip segment. Aquatic therapy is particularly well-tolerated for spondylolisthesis patients as buoyancy reduces spinal loading. Activity modification to avoid extension-loading activities (heavy lifting overhead, running on hard surfaces).
Important distinction: Conservative care manages symptoms — it does not reduce the slip or reverse the stenosis caused by it. High-grade or progressive spondylolisthesis with neurological deficit is not appropriate for prolonged conservative management.
Epidural steroid injections
Transforaminal or interlaminar epidural injections reduce nerve root inflammation at the level of the slip, providing temporary relief of leg pain and claudication. Useful for acute exacerbations and for patients who are not yet ready for surgery. Most patients with significant spondylolisthesis eventually outgrow the benefit of injections as the structural compression persists.
Surgery — chosen for your anatomy, not defaulted to fusion
When conservative care has failed or neurological deficits are present, surgery is the most reliable path to lasting improvement. Dr. Katsevman evaluates three surgical options for each spondylolisthesis patient — selecting based on grade, stability, stenosis pattern, and patient goals.
Three surgical approaches
The right surgery for your grade and stability
Most spine surgeons treating spondylolisthesis offer one or two of these options. Dr. Katsevman offers all three — and selects based on a careful evaluation of your specific slip, stability, stenosis, and goals.
The TOPS System (Total Posterior Spine) is an FDA Breakthrough Device for Grade I lumbar spondylolisthesis with moderate-to-severe spinal stenosis. After decompressing the canal, a TOPS implant is placed posteriorly — stabilizing the slipped segment in all planes of motion while preserving motion rather than eliminating it. No interbody cage. No bone graft. No rods fusing the level permanently.
In the FDA randomized clinical trial, TOPS achieved 77% overall clinical success versus 24% for fusion at 2 years — a dramatically superior outcome. Dr. Katsevman is listed on the official Premia Spine TOPS surgeon locator, one of very few surgeons in Florida trained and experienced with this system.
For patients with a stable Grade I spondylolisthesis where dynamic X-rays confirm the slip is not moving, and symptoms arise primarily from nerve compression rather than instability, minimally invasive tubular laminectomy can decompress the nerves without fusing the segment at all.
Dr. Katsevman’s tubular laminectomy preserves the spinous process, interspinous ligaments, and supraspinous ligaments — the posterior tension band that helps maintain spinal stability. By leaving these structures intact, the spine remains naturally stable after decompression, making fusion unnecessary in many patients who would have been fused elsewhere. Quarter-inch incision. Same-day discharge. No hardware. No restrictions at 6 weeks.
When the spondylolisthesis is unstable on dynamic X-rays, high-grade (II or above), or accompanied by significant deformity, fusion is the right surgical answer. Dr. Katsevman performs fusion with the precision and technology the procedure demands: EOS EDGE full-body alignment planning before surgery to determine optimal cage lordosis and rod contouring, and robotics and navigation for every screw placed — not as a marketing feature, but as a measurable improvement in hardware accuracy and patient safety.
Approach selection (ALIF, LLIF, TLIF, PTP) depends on the level, the degree of slip, the need for listhesis reduction, and patient anatomy. BMAC biologic augmentation is available to enhance fusion healing in at-risk patients (smokers, diabetics, osteoporosis).
Learn more
From Dr. Katsevman’s blog & related pages
Patient guides on spondylolisthesis, TOPS, and the surgical options available.
Common questions
What patients ask most
I have Grade I spondylolisthesis. Do I need fusion? +
Not necessarily — and this is one of the most important questions to get right before any surgical decision. Grade I spondylolisthesis is the most common grade, and many patients with Grade I slips have a stable vertebra that has not moved in years. Their symptoms — leg pain, claudication, limited walking — come from nerve compression caused by the canal narrowing at the slip level, not from active instability. For these patients, TOPS or minimally invasive decompression without fusion can relieve the nerve compression and resolve the symptoms without hardware, bone graft, or the recovery time of fusion. Dynamic (flexion-extension) X-rays are essential for evaluating true stability. Dr. Katsevman uses these routinely to avoid recommending fusion when it is not genuinely needed.
What is the TOPS procedure and how does it differ from fusion? +
TOPS (Total Posterior Spine System) is an FDA Breakthrough Device for Grade I spondylolisthesis with stenosis. After the nerves are decompressed, a TOPS implant is placed at the back of the spine — stabilizing the slipped segment in all directions while allowing normal range of motion. No interbody cage is placed. No bone graft is needed. No permanent fusion occurs. This is fundamentally different from lumbar fusion, which eliminates all motion at the treated level permanently. In the FDA randomized clinical trial, TOPS achieved 77% overall clinical success vs 24% for fusion at 2 years. Dr. Katsevman is one of the few surgeons in Florida listed on the official TOPS surgeon locator.
Will spondylolisthesis get worse over time if untreated? +
Degenerative spondylolisthesis typically progresses slowly over years to decades, if at all. Many Grade I slips remain stable for years without significant change. However, the associated stenosis tends to worsen progressively as disc degeneration, facet hypertrophy, and ligament thickening continue — even if the slip itself does not advance. The practical implication: even a stable spondylolisthesis can produce worsening symptoms over time as the canal continues to narrow at the slip level. This is why treatment decisions should be based on symptom trajectory and function, not just slip grade.
Can I return to full activity after spondylolisthesis surgery? +
Yes — the goal of surgery is to restore the activity the spondylolisthesis has taken away. For laminectomy without fusion, there are no activity restrictions at 6 weeks. For TOPS, return to normal activity follows a similar recovery arc. For lumbar fusion, the bone consolidation process takes 3–6 months, with gradual return to full activity over that period. Dr. Katsevman has patients who have returned to golf, pickleball, hiking, and demanding physical work after spondylolisthesis surgery. The type and extent of surgery determines the timeline — which Dr. Katsevman will discuss specifically at your consultation.
I have been told I need fusion for spondylolisthesis. Should I get a second opinion? +
Yes — particularly if you have Grade I spondylolisthesis. A surgeon who does not offer TOPS or minimally invasive laminectomy for stable spondylolisthesis will default to fusion regardless of whether the slip is truly unstable. A second opinion from a surgeon who offers all three approaches — TOPS, decompression alone, and fusion — gives you a complete picture of what is possible. Dr. Katsevman offers in-person and telemedicine second-opinion consultations. Bring your MRI and any flexion-extension X-rays. The conversation about stability versus compression is one that significantly changes treatment recommendations for many patients.
"The fusion conversation for spondylolisthesis should start with one question: is this slip actually moving? If it’s not, you may not need fusion — and the evidence for TOPS and decompression alone is strong."
Gennadiy (Gene) A. Katsevman, MD
Neurosurgeon & Minimally Invasive Spine Surgeon
Official Premia Spine TOPS™ surgeon locator — one of the few TOPS-trained surgeons in Florida
Only surgeon in Naples performing up to 3-level tubular laminectomy — posterior ligaments preserved, fusion often avoidable
EOS EDGE full-body alignment planning for every fusion case
Robotics and navigation on every fusion — hardware accuracy, not a marketing claim
BMAC biologic augmentation available for at-risk fusion patients
Fellowship-trained at Barrow Neurological Institute under Dr. Juan Uribe — minimally invasive spine pioneer
30+ peer-reviewed publications in spine surgery and neurosurgery
Naples Top Doctor in Neurosurgery — 2024, 2025, and 2026
5-star Google rating · Healthgrades Choice · WebMD Preferred · U.S. News Patients’ Top Choice
Take the next step
Told you need fusion?
Find out if you actually do.
Schedule a consultation with Dr. Katsevman in Naples or Fort Myers — or by telemedicine. Bring your MRI and X-rays. Walk out knowing whether TOPS, laminectomy, or fusion is right for your slip and your anatomy.
6101 Pine Ridge Road #101
Naples, FL 34119
Fort Myers, FL 33919
Available statewide & nationally