Spondylolisthesis Treatment Options

Spondylolisthesis is a spinal condition where one of the vertebrae slips forward over the vertebra below it. This slippage can cause back pain, leg pain, and other symptoms depending on the severity. Treatment options for spondylolisthesis depend on the degree of the slippage, symptoms, and the overall health of the patient. It can affect the cervical spine or the lumbar spine, but it is most common in the low back. Degenerative spondylolisthesis is most often found at lumbar vertebrae L4/5. Spondylolisthesis is graded based on the degree of slippage. Treatment depends on the symptoms and their severity.

Nonsurgical Treatments

For grades I and II, treatment typically begins with conservative management to relieve symptoms. This includes:

• Rest and activity modification: Avoiding activities that make symptoms worse such as bending, lifting, athletics and gymnastics.
• Physical Therapy: Exercises designed to strengthen the muscles supporting the spine can help reduce pain and improve function. A physical therapist may also teach stretching exercises to improve flexibility and relieve pressure on the nerves.
• Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, can help relieve pain and inflammation. Muscle relaxants may be prescribed to alleviate muscle spasms.
• Traction and Bracing: Wearing a back brace may help stabilize the spine and reduce discomfort, especially in mild cases of spondylolisthesis. A brace can provide temporary support while the spine heals.
• Epidural Steroid Injections: For more severe pain that radiates to the legs, epidural steroid injections may be recommended. These injections reduce inflammation around the nerves and provide temporary relief.

Surgical Treatments

High-grade spondylolisthesis should be treated surgically. When the cause is degenerative, and symptoms have not improved after 3-6 months of nonsurgical treatment Dr. Girardi may recommend surgery. This is especially true if you are unable to walk or stand and the pain and weakness negatively affects your quality of life.

The aim of surgery is to relieve nerve compression and prevent or treat instability. Other indications for surgery include progressive neurologic symptoms such as weakness, numbness or falling, and when symptoms are related to damages to the nerves below the end of the spinal cord, called cauda equina syndrome.

• Decompression Surgery (Laminectomy): This surgery removes a portion of the vertebrae (the lamina), bone spurs, and thickened ligaments to relieve pressure on the nerves. It is typically used when nerve compression causes significant symptoms such as leg pain or weakness. Recovery may take only 1-2 months.
• Spinal Fusion: In more severe cases or if nonsurgical treatments fail, and when there is spinal instability, spinal fusion may be necessary. Spinal fusion involves permanently connecting two or more vertebrae to prevent further slippage. Surgeons may use rods, screws, or bone grafts to achieve fusion. Patients can usually return to work after 4-6 weeks if work is not physical labor or 3-6 months if the patient has a physically demanding job. Full recovery can take 6 months to one year. Recovery involves post-operative physical therapy. Full recovery takes this long because it involves the use of bone grafts that grow and fuse. This takes time.
• Minimally Invasive Surgery: Minimally invasive surgery (MIS) for spondylolisthesis is an advanced treatment option that offers several advantages over traditional open surgery. It involves smaller incisions, less tissue trauma, reduced blood loss and minimal muscle disruption which reduces recovery times. Procedures include minimally invasive lumbar fusion, and minimally invasive decompression surgery (laminectomy).

Patients undergoing minimally invasive surgery for spondylolisthesis generally experience a shorter hospital stay, often returning home within a day or two. Recovery is typically faster, with less postoperative pain and a quicker return to daily activities.

Contact Dr. Girardi to schedule a consultation to learn more about your condition and discover all you treatment options. Dr. Girardi offers personalized expert orthopedic care to patients in New York, New Jersey, Connecticut and the Capital District Region, as well as international patients.

References

• Tenny S, Hanna A, Gillis CC. Spondylolisthesis. [Updated 2023 May 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430767/
• https://www.medicalnewstoday.com/articles/recovery-from-spinal-fusion#recovery-duration
• https://orthoinfo.aaos.org/en/diseases–conditions/adult-spondylolisthesis-in-the-low-back/