What are the treatment options for Spondylolisthesis?

From the Guidelines

Treatment for Spondylolisthesis typically involves conservative therapy with pharmacologic and nonpharmacologic interventions, such as exercise and remaining active, for at least 6 weeks before considering imaging or surgical options.

Treatment Options

• Conservative therapy: first-line treatment for chronic low back pain, including pharmacologic and nonpharmacologic therapy, such as exercise and remaining active 1
• Imaging: MRI of the lumbar spine is the initial imaging modality of choice to identify potential actionable pain generators, including disc degeneration, thecal sac, and neural structures 1
• Surgical options: may be considered for patients who have failed 6 weeks of conservative therapy, with imaging used to guide surgical or interventional options 1

Diagnostic Imaging

• MRI: excellent soft-tissue contrast, accurately depicts lumbar pathology, including disc degeneration, and neural structures 1
• CT myelography: useful in assessing patency of spinal canal/thecal sac and subarticular recesses, with safety advantages over MRI for patients with implanted medical devices 1
• Upright radiographs: provide useful functional information about axial loading, with flexion and extension radiographs essential to identify segmental motion in surgical management of spondylolisthesis 1
• CT lumbar spine: useful for preoperative planning, delineates osseous margins, and aids in trajectory planning for hardware fixation 1

From the Research

Treatment Options for Spondylolisthesis

The treatment options for spondylolisthesis can be categorized into conservative and surgical management.

• Conservative management includes:
  • Instruction in exercise and body mechanics 2
  • Use of back supports, such as antilordotic orthoses 2
  • Job modifications 2
  • Strengthening of the abdominals and paraspinal muscles, especially in the thoracic area 2
  • Deep-heat therapy, avoidance of maximal forward flexion of the lumbar spine, and bed rest in severe cases 2
  • Pain management with physical therapy 3
• Surgical management may be considered for patients who fail conservative therapy, and includes:
  • Decompression, stabilization, and fusion 3, 4, 5
  • Direct repair surgery of spondylolysis and low-grade spondylolisthesis 4
  • Dorsal, ventral, and combined dorsoventral surgery, with or without instrumentation 4
  • Reposition and fusion in situ without instrumentation 4

Indications for Surgical Management

Surgical management may be indicated in cases of:

• Progressive neurological deficits 5
• Cauda equina syndrome 5
• Failure of an adequate response to conservative therapy 5
• Radiographic instability with neurological symptoms 5
• Radiographic progression of subluxation to greater than grade II 5
• Symptomatic grades III, II, or spondyloptosis 5
• Unremitting pain that affects the quality of life 5