Degenerative Spondylolisthesis Treatment Options

Options include conservative nonsurgical treatment and surgery. The choice depends on the severity of symptoms and the degree of slippage. Conservative management is typically recommended initially, with surgery considered if conservative measures fail to alleviate symptoms effectively.

• Patients with back pain and no neurological deficits (loss of sensation, weakness, difficulty with coordination, and spasticity) do well with conservative treatments.
• Patients with neurological deficits tend to deteriorate without surgery.

Nonoperative treatment involves activity modification, bracing, physical therapy, NSAIDS anti-inflammatory medication for pain, epidural steroid injections, strength and posture training, and core training to regain range of motion and stabilize the spine.

Surgical intervention may be recommended to manage symptomatic spinal stenosis (persistent and incapacitating pain) combined with low-grade slippage in patients who try conservative management for 3-6 months and fail to find relief.

Studies report that surgical management of symptomatic degenerative spondylolisthesis and spinal stenosis treats pain and improves function, which leads to better clinical outcomes when compared to nonsurgical management.

Laminectomy

A laminectomy is decompression surgery aimed at relieving pain and functional impairments by alleviating pressure on the spinal nerves caused by spinal stenosis, the significant narrowing of the spinal canal that accompanies vertebral slippage.

The procedure involves removing part or all of the lamina, the back part of the vertebra that covers the spinal canal. Removing the lamina expands the space within the spinal canal to relieve pressure on the spinal cord or nerve roots. In addition to removing the lamina, during the procedure, Dr. Ball may also need to remove bone spurs that have formed due to the instability and are contributing to nerve compression.

A laminectomy is typically considered after nonsurgical treatments fail. The extent of vertebral slippage and the associated instability also play a crucial role in deciding the need for surgery. In more severe cases, a laminectomy might be combined with spinal fusion to stabilize the affected vertebrae.

Thus, a laminectomy for spondylolisthesis involves decompressing the nerve roots and addressing any structural causes of nerve compression, such as bone spurs and misaligned vertebrae, to alleviate symptoms and improve the patient’s functional abilities.

Rehabilitation involves rest initially and physical therapy to restore function. Recovery from an open or minimally invasive lumbar laminectomy can take only one to two months because the bones do not have to fuse.

Spinal Fusion

Spinal fusion is the standard surgical treatment for lumbar spondylolisthesis, which treats spinal instability and pain. It involves fusing or joining two or more vertebrae together with implants and bone grafts to stabilize the spine. The goal is to eliminate pain by eliminating motions at the spinal joints to prevent slippage.

Spinal fusion is considered degenerative spondylolisthesis when the condition leads to significant spinal instability, severe pain, and neurological symptoms like numbness, tingling, and weakness in the legs. The primary goal is stabilizing the affected vertebrae to reduce pain and prevent further slippage.

Spinal fusion for degenerative spondylolisthesis is a significant surgical intervention that is typically reserved for cases where nonsurgical treatments have failed and where symptoms significantly impair the patient’s quality of life.

Recovery from both open and minimally invasive spinal fusion can take up to six months. Physical therapy strengthens the back muscles and improves spinal stability and flexibility post-surgery. The success of spinal fusion largely depends on the fusion of the bone graft with the vertebrae, which can take several months.

Long-term outcomes generally include a significant reduction in pain and stabilization of the spine. However, spinal fusion can alter the spine’s mechanics, potentially leading to accelerated degeneration of the vertebrae adjacent to the fusion site (adjacent segment disease).

Surgery for degenerative spondylolisthesis offers successful outcomes in more than 85% of patients, and patients treated with surgery maintain substantial pain relief and functional improvements when compared to patients who were treated nonsurgically.