Is retrolisthesis serious?

Usually not. Most are grade 1 — a few millimetres — and arise from ordinary disc wear. It becomes more significant if it narrows the exits the nerve roots use and there are matching symptoms in an arm or leg. The grade alone does not decide it.

Can retrolisthesis be reversed?

The alignment itself is not something exercise or manipulation reliably corrects, because it follows from the height the disc has lost. What treatment addresses is the symptoms and the strength and mobility around the segment. Be cautious with anyone promising to put the vertebra back.

Low-grade retrolisthesis is generally stable. It can progress slowly if the disc continues to degenerate, but sudden or large progression is unusual and would be investigated on its own terms.

Why does my X-ray show it and my MRI does not?

Because of position. X-rays of the spine are often taken standing, which loads the segment and can reveal a slip; MRI is done lying down, which unloads it. Both images are accurate about the position they were taken in.

Is it the same as spondylolisthesis?

It is the same measurement in the opposite direction. Spondylolisthesis, or anterolisthesis, is a forward slip; retrolisthesis is backwards. Forward slips have some causes that backward slips do not, which is why the two are named separately.

Findings explained

What “retrolisthesis” means on a spine report

Read Your Scan Editorial Team·Last updated 10 September 2026·5 min read

Written from published radiology references and reviewed for plain language. Not written or signed by a physician, and not a diagnosis. How we write these pages →

Sagittal MRI of the cervical spine — A real sagittal MRI of the neck — the view a slip is judged on. The front edges of the vertebral bodies should line up in a smooth column; retrolisthesis is described when one sits behind that line. This study is reported as showing degenerative changes.Real exam · Stillwaterising · CC BY-SA 3.0

The short answer

Retrolisthesis means one vertebra has slipped slightly backwards relative to the one beneath it. It is measured in millimetres and graded by how far it has moved. In adults it is nearly always a consequence of the disc between the two bones losing height, not of an injury, and small degrees of it are common and often cause nothing at all.

It is the backwards version of the more familiar slip. Spondylolisthesis is forwards; retrolisthesis is backwards.
The usual cause is disc wear. As a disc flattens, the joints at the back let the vertebra settle backwards.
It is graded 1 to 4 by how much of the vertebra’s width has shifted. Grade 1 — under a quarter — is by far the commonest.
It is often visible on an X-ray taken standing and absent on an MRI taken lying down. Both can be true of the same spine.
What decides whether it matters is nerve symptoms, not the millimetres.

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What the word describes

A spine is a stack. Seen from the side, the front edges of the vertebral bodies should trace a smooth line. When one vertebra sits a little behind that line relative to the one below it, the report calls it retrolisthesis.

The prefix is the whole content of the word. "Listhesis" means slippage; "retro" means backwards. The commoner forward version is spondylolisthesis, or anterolisthesis. Same measurement, opposite direction.

The measurement is in millimetres, taken on a side-on image. Which image matters: a standing X-ray loads the spine, an MRI does not, and a slip that shows up standing can disappear lying down. If two reports disagree, that is usually why.

Why a vertebra slips backwards

In adults, almost always because the disc in front has lost height. The disc is a spacer; when it thins, the two vertebrae come closer together, and the small joints at the back of the spine — which are angled — allow the upper one to settle slightly backwards as it descends.

Disc degeneration and loss of disc height. The dominant cause, and the reason retrolisthesis appears in the same reports as disc desiccation and osteophytes.
Facet joint wear, which loosens the guiding surfaces that would otherwise hold alignment.
Previous injury, in a minority.
Previous spinal surgery at an adjacent level.
Occasionally, generalised ligament laxity.

This is why it clusters in the lower lumbar spine and the lower neck: those are the levels that carry load and wear first.

Sagittal T2 MRI of the lumbar spine with degenerative disc changes — A lumbar spine with degenerative disc change on the same kind of view. This is the setting retrolisthesis usually arises in: as the discs lose height, the alignment of the column above and below them changes with them.Real exam · Ptrump16 · CC BY-SA 4.0

What the grade means

Slips are graded by how far the vertebra has moved as a fraction of the width of the bone below it.

Grade	How far it has moved
Grade 1	Up to a quarter of the width. By far the commonest, and the one most reports describe.
Grade 2	A quarter to a half.
Grade 3	A half to three quarters.
Grade 4	More than three quarters.

Higher grades of retrolisthesis are uncommon. Most reports that mention it are describing 2 to 4 millimetres, which is grade 1, and many will simply say "minimal" or "mild" without giving a grade at all.

Does it cause the pain?

Sometimes, and the honest answer is that a small slip on its own is a weak explanation. Retrolisthesis is found in people with no back pain, and the disc degeneration that produces it is itself so common with age that separating cause from coincidence is difficult.

It becomes more clinically meaningful when the backwards shift narrows the space the nerve roots leave through. A vertebra sitting backwards can reduce the size of those exits, and if the report also describes foraminal narrowing or nerve root compression at the same level as symptoms in the matching limb, the pieces fit together.

The question worth asking is not "how many millimetres" but "is anything being compressed, and does it match my symptoms". The millimetres are a description; the nerve is the clinical question.

What usually happens next

For a low-grade slip without nerve symptoms: nothing specific. It is managed as ordinary degenerative back or neck pain — movement, physiotherapy, strengthening, and analgesia if needed. There is no treatment aimed at pushing the vertebra back into line.

Where there are nerve symptoms that match the level, the assessment shifts to what is being compressed, and options run from targeted physiotherapy through injections to surgery in a minority.

Repeat imaging is rarely useful unless something changes clinically. A grade 1 retrolisthesis is usually stable over years.

Frequently asked questions

Is retrolisthesis serious?: Usually not. Most are grade 1 — a few millimetres — and arise from ordinary disc wear. It becomes more significant if it narrows the exits the nerve roots use and there are matching symptoms in an arm or leg. The grade alone does not decide it.
Can retrolisthesis be reversed?: The alignment itself is not something exercise or manipulation reliably corrects, because it follows from the height the disc has lost. What treatment addresses is the symptoms and the strength and mobility around the segment. Be cautious with anyone promising to put the vertebra back.
Will it get worse?: Low-grade retrolisthesis is generally stable. It can progress slowly if the disc continues to degenerate, but sudden or large progression is unusual and would be investigated on its own terms.
Why does my X-ray show it and my MRI does not?: Because of position. X-rays of the spine are often taken standing, which loads the segment and can reveal a slip; MRI is done lying down, which unloads it. Both images are accurate about the position they were taken in.
Is it the same as spondylolisthesis?: It is the same measurement in the opposite direction. Spondylolisthesis, or anterolisthesis, is a forward slip; retrolisthesis is backwards. Forward slips have some causes that backward slips do not, which is why the two are named separately.

When you want a second read of the images themselves

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Sources

Patient-facing procedure descriptions (MRI, CT, X-ray, ultrasound)RadiologyInfo.org — Radiological Society of North America & American College of Radiology
MRI scan — overview, how it is performed and resultsNHS (United Kingdom)
ACR Appropriateness Criteria and practice parameters for reportingAmerican College of Radiology

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Read Your Scan is informational only — not a medical diagnosis, and not a substitute for a licensed radiologist or your doctor. This page explains what a report says and what a radiologist looks at; it cannot tell you what your own images show. If you have urgent symptoms, seek care.