Lumbar Spondylolisthesis Treatment Options

Degenerative lumbar spondylolisthesis is one of the most common causes of low back pain affecting about 11.5% of Americans. It is more common in women and people over the age of 65. No single treatment works best for everyone. Our spine experts at Dallas Neurosurgical & Spine will work with you to find meaningful relief for your symptoms.

Anatomy of a vertebra

Every vertebra is composed the body and a pair of facet joints. In between each vertebra is a disc. The discs are shock absorbers. The facet joints allow us to bend forward and backward and restrain rotation of the spine. Each facet joint has a hole in it called a foramen through which the nerve roots pass.

What causes lumbar spinal instability?

Degenerative spondylolisthesis occurs because of the aging process including degenerative disc disease and aging facet joints that allow excessive forward bending which permits a vertebra to slip forward on the vertebra below it. It usually affects L3-4 and L4-5 but can involve more than one level. 

How is it spinal instability diagnosed?

Your DNS spine expert will ask about your symptoms, conduct a physical exam, and order imaging studies to evaluate your lumbar spine. This may include x-rays, an MRI, and a CT scan. Each of our neurosurgeons has completed seven years of advanced and specialized training in the diagnosis and treatment of spine disorders including complex and minimally invasive procedures.

What are the treatment options?

Conservative Treatment

Initially, lumbar spondylolisthesis is often treated with conservative measures including activity modification, rest, hot and cold therapy, anti-inflammatory medications, epidural injections, and bracing; and physical therapy to strengthen back and core muscles.

When pain and disability remain after conservative treatment, and there is persistent progressive deterioration surgery will be recommended. The goal of surgery is to remove pressure on the spinal nerves (decompression), realign the spine and restore spinal stability.

Lumbar Fusion Surgery

Lumbar fusion is the most common surgical treatment for degenerative spine disease and the most reliable approach to treating spondylolisthesis. Studies report that lumbar fusion for degenerative spondylolisthesis is superior when compared to conservative treatment.

Generally, most spinal fusion surgery involves:

• Nerve decompression. The removal of part or all or a degenerated disc and/or enlarging the narrowed foramen to relieve pressure on the nerves and realign the spine.
• Removal of the degenerated disc or damaged bone creates a space in the spine which must be filled to stabilize the spine to prevent painful motion. This requires healing the two bones together. This may include placing a spacer to span the disc space. The use of bone graft and/or bone healing substances is often used to enhance the fusion of the two bones. The graft may be created from bone taken from your body (autograft) or from a donor (allograft).
• Spinal stabilization. Mechanical stabilization with screws and rods fix the affected vertebrae to stabilize the spine, prevent slippage and enhance fusion rates. As the spine heals the graft will fuse the vertebrae together.

Surgical Techniques

There are various fusion techniques that have been found to be superior to conservative treatment for spondylolisthesis in well – selected patients. Many of these procedures are minimally invasive.

Spinal fusion offers restoration of disc height, and decompression of nerves, improved function, and a substantial reduction in pain.

Dallas Neurosurgical & Spine physicians are uniquely trained to perform spinal fusion surgeries with a minimally invasive approach. This allows for less postoperative pain, fewer days of recovery and a quicker return to work and play.

All these surgical techniques require specialized training in diagnosis, careful patient selection and surgical procedures. Patients must be reasonably healthy and willing to commit to rehabilitation to restore function.

When you meet with one of our excellent spinal surgeons they conduct a complete review of you general health and your condition. They will review with you the potential benefits, risks, and complications of associated with spinal fusion surgery. Full recovery from surgery can take up to a year.

Contact Dallas Neurosurgical & Spine to schedule a consultation to get the correct diagnosis and all your treatment options.