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 the 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 the symptoms of the condition.
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 and 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. It is typically used in patients that continue to notice symptoms even when physical rest does not provide symptomatic 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 local anaesthetic to reduce the pain of administration.
Patients with severe pain that is unresponsive to other treatment techniques may benefit from surgery. However, the procedures are associated with a risk of injury to the nerves in the spinal canal, and the benefits of surgery should be balanced against the risks before proceeding.
Most surgical procedures are carried out under general anesthetic. Vertebral fusion is the most common procedure used the treatment of spondylolisthesis and involved the connection of slipped vertebra to the neighboring vertebra with screws or rods that are installed permanently. If the spinal disc is compressed, if 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 complication 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 and Maintenance
It is important that adequate techniques to reduce symptoms recurrence are employed when patients reach a state with minimal symptoms and improve their quality of life.
This usually comprises of continued physical therapy exercises to maintain muscular strength and 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 the spinal slippage and associated symptoms. X-ray examinations can be used to monitor spinal changes and implement preemptive treatment plans as needed.