The treatment for patients with spondylolisthesis depends on the severity of the condition and the extent of movement of the vertebra.
Most individuals are able to significantly improve their symptoms of the condition with physical therapy to strengthen the muscles of the lower back. However, some patients may require pharmaceutical pain relief and surgical procedures to manage their symptoms.
Treatment for Spondylolisthesis
Physical therapy
When patients are experiencing symptoms of spondylolisthesis, the initial step in the management plan should be adequate rest in bed to allow the pain to subside and the inflamed tissue to recover naturally.
Following this, physical therapy can offer a benefit to help strengthen the muscles in the lower back and reduce the risk of symptom recurrence. Simple physical exercises can be employed to improve the flexibility and strength of the involved muscles. A physiotherapist can help to make recommendations for the appropriate exercises and monitor the physical progress of the individual.
In the treatment period, the patient should avoid participating in contact sports or other activities that may overstretch the spine. If the employment of the individual has a strong demand for physical labor, they may need to take some time away from work.
In some cases, a back brace is recommended to limit the movement of the spine and help to prevent symptoms. However, this practice is controversial, as it may lead to muscular atrophy and heighten the risk of symptoms when the brace is removed. This treatment approach is typically used in patients who continue to notice symptoms even when physical rest does not provide symptomatic relief.
Pain relief
Some patients will require pain relief to help improve their quality of life when the pain associated with the condition is significant. These pain relief medications are able to provide temporary relief from the pain but are not useful in the long-term improvement of symptoms.
Initially, oral non-steroidal anti-inflammatory drugs (NSAIDs) are usually recommended, as they can help to reduce the inflammation that is causing the pain.
Stronger pain relief is sometimes required, in which case steroid medications can be injected into the spinal canal, which is conducted with a local anesthetic to reduce the pain of administration.
Surgery
Patients with severe pain that is unresponsive to other treatment techniques may benefit from surgery. However, these procedures are associated with a risk of injury to the nerves in the spinal canal; therefore, the benefits of surgery should be considered against the risks before proceeding.
Most surgical procedures are carried out under general anesthesia. Vertebral fusion is the most common procedure used in the treatment of spondylolisthesis and involves the connection of slipped vertebra to the neighboring vertebra with screws or rods that are installed permanently. If the spinal disc is compressed, it can be removed and replaced with a bone graft cage to keep the vertebrae separated.
Surgery can be very beneficial for some patients but is associated with complications that may affect some recipients. These include infection at the site of surgery, deep vein thrombosis due to extended bed rest, and damage to the nerves, which can lead to numbness, weakness, or paralysis of the lower limbs.
Follow up care
It is important that adequate techniques to reduce symptom recurrence are employed when patients reach a state with minimal symptoms.
This usually involves the continuance of physical therapy exercises to maintain muscular strength, as well as routine follow-up tests to monitor the movement of the spine. Patients should be advised to avoid activities that require them to hyperextend their spine, as this is linked to worsening of spinal slippage and its associated symptoms. X-ray imaging can be used to monitor spinal changes and implement preemptive treatment plans as needed.
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