Lumbar Spondylolisthesis Treatment Options

Degenerative lumbar spondylolisthesis is one of the most common causes of low back pain. It is defined as displacement of one vertebra over the vertebra below leading to spinal canal stenosis. The mainstays of surgical treatment are decompressive laminectomy with or without spinal fusion. Studies report that surgery provides significant benefits for patients including improved quality of life.

Most patients without neurological symptoms do better with conservative non-surgical management. Neurological symptoms include radiating pain and numbness and tingling in the buttocks, thighs and legs, muscle weakness, loss of reflexes in the worst-case bowel and bladder dysfunction. Patients with these symptoms are prone to progressive functional deterioration without surgery.

  1. Physical therapy: Strengthening the core and back muscles can provide added support to the spine and reduce pain and improve strength, flexibility and balance. Your therapist may also introduce stretching exercises to improve flexibility and maintain a range of motion.
  2. Pain relief medication: non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can help manage the pain and reduce inflammation. If OTC medications aren’t sufficient, muscle relaxants, corticosteroids, or even opioids might be recommended.
  3. Bracing: In some cases, wearing a back brace can help provide support and reduce pain. This is typically not done for a prolonged period of time as it can weaken the support muscles of the spine.
  4. Epidural Steroid Injections: If pain continues despite conservative treatment, your doctor may recommend steroid injections. These are administered directly into the area around the nerves of your spine and can help reduce inflammation and alleviate pain.
  5. Weight Loss and Lifestyle Modifications: Maintaining a healthy weight reduces stress on the spine. Avoiding long periods of standing or sitting can prevent aggravation of pain. Quitting smoking, staying active, and maintaining good posture can also help manage symptoms.

Laminectomy or Laminotomy (Decompression Surgery)

Decompression surgery is the gold standard surgery aims to relieve pressure on the spinal nerves by removing or trimming structures that are compressing the nerves, such as bone or tissue. The most common type of decompression surgery for spondylolisthesis is called a laminectomy or laminotomy. The goal is to create more space for the nerves. Decompression surgery can alleviate symptoms such as pain, numbness, or weakness caused by nerve compression.

Spinal Fusion

Spinal fusion is a surgical procedure that aims to stabilize the spine by fusing two or more vertebrae together. The procedure typically involves removing the intervertebral disc between the affected vertebrae and using bone grafts, spacers, or implants (such as screws, rods, or cages), or a combination of both to promote fusion and restore disc height. Spinal fusion helps to reduce the slippage of the vertebrae, improve spinal stability, and alleviate symptoms.Different techniques can be used for spinal fusion, including posterior fusion (from the back), anterior fusion (from the front), or a combination of both (360-degree fusion). Common approaches for interbody fusion include anterior lumbar interbody fusion (ALIF), posterior lumbar interbody fusion (PLIF), transforaminal lumbar interbody fusion (TLIF), and lateral lumbar interbody fusion (LLIF). Interbody fusion techniques provide additional stability, restore disc height, and may indirectly correct the spondylolisthesis.

Minimally Invasive Surgery (MIS)

Some surgical procedures for spondylolisthesis can be performed using minimally invasive techniques, which involve smaller incisions, less tissue disruption, and potentially faster recovery times.The specific surgical approach for treating spondylolisthesis depends on factors such as the severity of the slip, the patient’s symptoms, goal and individual characteristics, and the surgeon’s expertise.

It’s important to have a thorough discussion with a Dallas Neurosurgical & Spine neurosurgeon who can review your imaging and symptoms, and discuss the best treatment options for you. Our goal is to perform the least invasive, most effective procedures available tailored to your needs. We have offices in Plano, Frisco, and Dallas and offer virtual visits as well.

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