Treatment for Spondylolisthesis | Treatment and Prognosis

Spondylolisthesis occurs when one of the bones in the spine (vertebrae) slips forward onto the bone below it. This can cause lower back pain that radiates to the legs, as well as numbness or tingling. Treatment options for spondylolisthesis aim to relieve these symptoms and prevent further slippage.

Non-Surgical Treatments

Rest and Activity Modification

When you are first diagnosed with spondylolisthesis, one of the key recommendations will likely be to avoid activities that worsen pain and give your back proper rest. This means restricting exercise, sports, and even daily tasks like bending and lifting heavy objects.

It’s frustrating to drastically limit your activity level, but this early rest period is crucial to allow fractured areas to start healing. Small microfractures or cracks in the pars interarticularis region of your vertebrae can worsen quickly without adequate rest. Resting for 4-6 weeks can help relieve pressure on nerves and let tissue inflammation settle down.

Follow your physician’s specific recommendations on restricting various movements and activities. While complete bed rest was once prescribed, doctors now favor gentle walking and modified daily tasks to avoid muscle atrophy. Finding the right balance of rest is key in the early treatment stages.

Medications

Anti-inflammatory medications are often recommended to help relieve swelling and pain associated with spondylolisthesis. These include over-the-counter options like:

• Ibuprofen (Motrin, Advil)
• Naproxen (Aleve).

Your physician may also prescribe muscle relaxants if you are experiencing significant muscle spasms.

For more severe nerve-related pain, your doctor might temporarily prescribe narcotics/opioids. These should only be used under careful monitoring due to their addiction potential.

Medications can provide critical pain relief in the initial healing phase. Make sure to take them as directed by your physician and communicate openly about your pain levels.

Steroid Injections

If anti-inflammatory medications are not providing enough pain relief, your doctor may recommend injecting corticosteroid medication directly into the epidural space around affected nerves. Steroids help reduce inflammation that is putting pressure on your spinal nerves.

Epidural steroid injections involve inserting a needle near problem areas in your spine. Medication is then injected and provides localized, potent anti-inflammatory effects. Many patients experience significant pain relief from just one injection, but you may need multiple rounds.

Potential side effects are rare but can include bleeding or infection. Make sure to discuss the pros and cons with your physician.

Physical Therapy

Once the most acute inflammation phase passes, physical therapy becomes a critical part of treatment. Seeing a physical therapist (PT) 2-3 times per week can help you regain mobility and strength.

Your PT will design a customized program targeting the muscles supporting your lower spine. This typically involves:

• Core strengthening exercises to improve stability
• Flexibility training to reduce tightness in the hamstrings and hip flexors
• Posture retraining to take pressure off damaged areas

With consistent PT, most patients see reduction in symptoms over 6-12 weeks as supporting muscle groups get stronger. Communication with your therapist ensures you progress at a safe pace and don’t overdo activities.

Physical therapy helps you regain strength and movement after injury or fractures related to spondylolisthesis. Steady improvement keeps motivation high to stick with the challenging exercise program.

Braces and Supports

For spondylolisthesis specifically caused by fractures in vertebrae, wearing a rigid back brace can provide extra spine stability. Bracing helps limit spine movement, allowing small stress fractures to heal properly.

Braces are most often used for teenagers with this condition, who need to stay active for school and work. The rigid plastic or metal prevents the spine from moving during activity, while still allowing flexibility for some movement.

Wearing a brace can feel restrictive and uncomfortable initially. Working with an orthotist ensures proper customized fit. You’ll need to wear it any time you are upright and active until adequate healing occurs – usually around 4-6 months.

Surgical Options

If nonsurgical spondylolisthesis treatment fails to improve disabling symptoms, your physician may discuss surgical options like spinal decompression or fusion.

Spinal Decompression

The main goal of spinal decompression surgery is to relieve pressure on compressed nerves that is causing pain. This involves removing portions of bone, ligaments or intervertebral disks to give nerves more space.

Techniques like laminectomy and foraminotomy are two common approaches:

• Laminectomy – Removal of part or all of the lamina bone and ligaments to increase space in the spinal canal.
• Foraminotomy – Widening of the neural foramen openings where nerves exit the spinal canal to give more room.

Combining decompression techniques provides the most nerve relief possible in one surgery session. Patients can expect some postoperative soreness and a 5-7 day hospital stay.

While surgery carries standard risks like bleeding and infection, spinal decompression is generally very safe when performed by an experienced neurosurgeon. Nerve pain relief can be significant, especially when pressure has built up over time on major nerves like the sciatic nerve.

Spinal Fusion

Since spondylolisthesis involves instability in the spine’s alignment, spinal fusion is often recommended in combination with decompression.

Fusion surgery uses instrumentation like rods, screws and bone grafts to permanently join affected vertebrae together. This prevents bones from slipping forward in the future.

During the procedure, your surgeon will first decompress nerves adequately. Bone grafts are then placed along the vertebral bodies in the slipped segment of spine. Finally, a constructed metal implant is affixed internally with screws to stabilize the graft material as it fuses.

The hospital stay usually lasts 4-5 days. While the first week of recovery can involve significant postoperative pain, this gradually improves over 8-12 weeks. Medications and walking help manage discomfort during the fusion and bone healing process.

Most patients return to normal activities by 12 weeks post-surgery. Lifting restrictions protect the fusion while the vertebral bones integrate into one solid segment. Follow-up x-rays will monitor your progress.

Fusion eliminates motion between the unstable segments that were causing nerve compression. Stopping the vertebrae from slipping further provides long-term relief.

Direct Pars Repair

In spondylolisthesis caused specifically by spondylolysis fractures in the pars interarticularis region of the vertebrae, direct repair may be considered. This approach saves motion rather than fusing vertebrae together.

The surgery involves placing screws across the pars defect or using cerclage wire to help compress small fractures. Bone graft material is layered to stimulate accelerated healing. Braces are worn after surgery to limit spine movement for 3-4 months while the area restores strength.

Direct pars repair is mainly considered in young patients still growing, like teenagers. The goal is stabilizing and healing defects before they progress to severe slippage and nerve compression.

Careful patient selection ensures pars defects are stable enough for a repair approach rather than spinal fusion. Patients with chronic slippage and instability still undergo fusion procedures.

Determining Best Course of Treatment

Deciding on conservative vs. surgical care depends greatly on individual circumstances:

Key Factors to Consider

• Grade of slippage – Low grade (less than 50% slip) generally responds better to nonsurgical treatments before considering decompression/fusion surgery
• Age and health status – Older patients with osteoporosis and comorbidities have higher surgical complication risks
• Degree of pain/disability – Worsening neurological symptoms (leg pain, tingling, weakness) despite thorough nonsurgical attempts indicate need for surgery

Open discussion with your treatment team on expected benefits vs. risks helps determine if surgery is appropriate. Conservative care is still successful for many patients if given adequate time.

The Importance of Shared Decision Making

Choosing the right spondylolisthesis treatments involves weighing many complex variables. Latest research shows “shared decision making” between doctor and patient optimizes satisfaction and outcomes.

Do your own homework by researching reputable medical sites and asking questions. But also listen to the nuanced opinion of spine experts most familiar with your case when forming opinions.

Getting on the same page with your physicians regarding treatment goals, expectations, and limitations is key. Patience and open-mindedness allows the process to unfold.

Outlook and Prevention

Long-Term Outlook

With appropriate treatment for spondylolisthesis, most patients see significant improvement in symptoms, especially leg and nerve pain. Positive outcomes depend greatly on factors like age, grade of slippage, and comorbidities.

Younger patients have better healing capacity and recover more fully from conservative treatments or surgery. Their complication risk is also much lower. Older individuals often take longer to bounce back and may have recurring issues with arthritis or degeneration.

Regardless of age, strict adherence to all therapy and activity restrictions optimizes recovery. Reinjury can set progress back or lead to worsening nerve compression. Some recurrence risk always exists but is minimized by building core and leg strength long-term.

Realistic outlook discussions with your spine specialist help set expectations. Patience in the recovery process is essential.

Preventative Exercises

Once recovery milestones are reached after spondylolisthesis treatment, regular core and posture exercises become vital for the rest of your life. These key areas to target include:

• Core muscle groups – The muscular corset around your abdomen and lower back works to stabilize your spine. Various Pilates moves, planks, and yoga poses target these essential areas.
• Glutes and hamstrings – Tightness in these muscle groups rotates the pelvis and strains the lower spine. Stretches, massage, and strengthening moves are key.
• Shoulders and chest – Good upright posture originates with proper shoulder positioning. Opening up the front of the chest and mid-back allows easier spinal alignment.

Building core strength and flexibility minimizes abnormal vertebral movement. This keeps nerve compression risks lower long-term.

Consult your PT or trainer on constructing a customized program that becomes a regular lifelong habit. This prevents future spondylolisthesis pain and progression.

Conclusion

Spondylolisthesis treatment entails patience through various nonsurgical modalities like medication, injections, bracing, and PT. Surgery is considered if severe slippage exists or symptoms persist despite exhaustive conservative efforts. Close partnership with your spine specialist determines the optimal plan.

Staying active through recovery while respecting one’s limitations is crucial. Small, gradual improvements add up over the many months of rehabilitation and beyond. Sticking diligently to core strengthening and posture regimens prevents recurrence.

With time and perseverance, most spondylolisthesis cases improve substantially, especially when caught early. Some periodic flare-ups may happen but should not discourage one from leading a full life. Each tiny gain serves as its own motivation.