Spondylolisthesis Treatment

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Spondylolisthesis Overview

Causes and Types of...

Signs and Symptoms

Conservative Treatment

Surgical Options and Recovery

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Surgical Correction with instrumentation

Video animation of surgical correction using new instrumentation

"A Slipped Vertebra"

Conservative Treatment Options

Most people with spondylolisthesis will find improvement in their back pain with conservative care. The foundation of a conservative program typically includes a short course in physical therapy leading to a daily home exercise program.

Developing a strong trunk (abdominal, oblique, and back muscles) is vital to removing stress and pain from the spine. Patients find that when they remember to do their back and abdominal exercises regularly, they have less back and buttock pain. The time commitment for exercises need not be longer than 10 minutes a day, in most cases.

Medications can play a role in pain control. Pain killers such as Percocet, Vicodin, and other narcotics are used sparingly except in times of new onset of severe pain. These narcotics are best used short term. They are very addictive. Non-steroidal anti-inflammatory medications are the medications of choice. They can be helpful at controlling back and leg pain by reducing the inflammation from arthritic joints. Muscle relaxants are rarely helpful, with the possible exception in the case of an acute muscle strain.

Surgical Options

Who Needs Surgery - There is only one circumstance where surgery is an emergency: cauda equina syndrome. This is a condition where the nerve roots within the spinal canal are severely compressed. The end result is loss of bowel or bladder control, severe leg pain, and numbness in the genital region. If the pressure on the nerves is not released immediately, control of bowel and bladder may never be recovered. For this reason, we consider cauda equina syndrome a surgical emergency.

For all other patients with spondylolisthesis, there is no emergency. Surgery is planned when symptoms or circumstances warrant it. Reasons to consider surgery include:

Back pain failing to improve with conservative care

Leg pain failing to improve with conservative care

Progressive leg or foot numbness or weakness

Progression in the amount of vertebra slippage

High grade spondylolisthesis (grades 3 - 5)

Signs, symptoms, and presence of nerve compression failing conservative care

"What If I Don't Have Surgery?"

Since surgery is usually done for relief of pain, the decision to postpone surgery is essentially a decision to live with the pain a bit longer. Most patients know very clearly when they are ready to have their spinal problem surgically corrected. Their pain is intrusive and constant, work is difficult, social life or hobbies are impossible, family life is compromised, and the level of function is in every way sub-optimal.

Risks of Surgery - As with any surgery, there are risks with spinal surgery to correct spondylolisthesis. The risks depend on the procedure being performed, the complexity of the spinal problem, and the health of the patient. Some of the more common problems with posterior surgery (surgery from the back) include infection (1-3%), failure of fusion (3-15%), nerve root injury (1%), dural leak (1-5%), hardware failure (1%), and excessive blood loss (5%).

Complications unique to anterior surgery (surgery through the abdomen) include prolonged resumption of bowel function, injury of blood vessels or bowel, incisional hernia, and retrograde ejaculation in males (1-3%).

General complications that can occur with any surgery include blood clots, deep vein thrombosis, pulmonary embolus, heart attack, pneumonia, urine infection, incision infection, virus transmission through blood transfusion, and many others. The general health risk from surgery depends on the health of the patient. A complete physical is recommended for anyone with health problems before undergoing major spinal surgery.