From the Research
Management of anterolisthesis should prioritize conservative approaches, including physical therapy and pain management, before considering surgical intervention, as supported by the most recent and highest quality study 1. The goal of treatment is to alleviate symptoms, improve quality of life, and prevent progression of the condition. Conservative management typically includes:
- Physical therapy focused on core strengthening and spinal stabilization exercises
- Pain management with NSAIDs like ibuprofen or naproxen
- Muscle relaxants such as cyclobenzaprine for associated muscle spasms
- Activity modification to avoid movements that exacerbate symptoms
- Epidural steroid injections for persistent pain
- Bracing to limit motion and provide support in some cases
If conservative measures fail after 6-12 months, or if there's significant neurological compromise or progressive slippage, surgical intervention may be necessary. Surgical options include:
- Decompression procedures to relieve nerve pressure
- Spinal fusion to stabilize the affected vertebral segments
- Both combined, depending on the grade of anterolisthesis, location, patient age, overall health, and presence of neurological symptoms
Regular follow-up imaging is crucial to monitor for any progression of the vertebral slippage, especially in younger patients with developmental anterolisthesis, as highlighted in 2 and 1. The choice of treatment should be individualized, taking into account the patient's specific condition, symptoms, and overall health, with the aim of optimizing patient outcomes and improving quality of life, as emphasized in 1.