Treatment for Mild Retrolisthesis at L2-L3
Conservative management should be the first-line treatment for mild retrolisthesis at L2-L3, with surgery reserved only for cases that fail to respond to non-operative measures and have significant neurological symptoms or instability. 1, 2
Initial Conservative Management
- Begin with physical therapy focusing on core strengthening, spinal stabilization exercises, and proper body mechanics to improve spinal alignment and reduce stress on the affected segments 2
- Pain management with non-steroidal anti-inflammatory drugs (NSAIDs) or other analgesics as needed to control symptoms 3
- Activity modification to avoid positions and activities that exacerbate symptoms 2
- Consider supervised exercise programs that focus on strengthening the paraspinal and abdominal muscles to provide better support for the spine 4
Advanced Conservative Options
- Epidural steroid injections may be beneficial for patients with radicular symptoms associated with the retrolisthesis 3
- Chiropractic care with specific manipulative techniques has shown benefit in some cases of retrolisthesis, with potential for gradual reduction of the retrolisthesis over time with consistent maintenance care 2
- Bracing may be considered in some cases, though evidence for its effectiveness specifically for retrolisthesis is limited 4
Surgical Considerations
- Surgery should be considered only after failure of conservative management for at least 3-6 months and when there are significant neurological symptoms or progressive instability 4
- For patients with retrolisthesis and associated spinal stenosis without significant instability, decompression alone may be sufficient 1
- For patients with retrolisthesis and significant instability or associated spondylolisthesis, decompression with fusion is recommended 4
- Lumbar fusion may be appropriate for patients with chronic low back pain due to retrolisthesis that is refractory to conservative treatment 4
- Pedicle screw fixation should be considered in cases with kyphosis or excessive motion at the site of the retrolisthesis 4, 1
Monitoring and Follow-up
- Regular radiographic assessment to monitor for progression of the retrolisthesis 5
- Continued home exercise program even after symptomatic improvement to maintain spinal stability 2
- Consider monthly maintenance care for patients with recurrent symptoms to prevent progression and maintain optimal spine function 2
Special Considerations
- Traumatic retrolisthesis is a different entity from degenerative retrolisthesis and typically requires surgical intervention with decompression and stabilization 6
- Older patients with retrolisthesis may have additional degenerative changes that need to be addressed in the treatment plan 7
- The presence of neurological deficits, especially progressive ones, should prompt more urgent surgical evaluation 1, 6