Spondylolisthesis (cont.)
What is the treatment for spondylolisthesis?
The initial treatment for spondylolisthesis is conservative and based on the
symptoms.
- A short period of rest or avoiding activities such as lifting and
bending and athletics may help reduce symptoms.
- Physical therapy can help to
increase range of motion of the lumbar spine and hamstrings as well as
strengthen the core abdominal muscles.
- Anti-inflammatory medications can help
reduce pain by decreasing the inflammation of the
muscles and nerves.
- Patients with pain, numbness and tingling in the legs may
benefit from an epidural steroid (cortisone) injection.
- Patients with isthmic spondylolisthesis may benefit from
a hyperextension brace. This extends the lumbar spine bringing the two portions
of the bone at the defect closer together and may allow for healing to occur.
For patients whose symptoms fail to improve with
conservative treatment surgery may be an option. The type of surgery is based on
the type of spondylolisthesis. Patients with isthmic spondylolisthesis may
benefit from a repair of the defective portion of the vertebra, or a pars
repair. If an MRI scan or PET scan shows that the bone is active at the site of
the defect it is more likely to heal with a pars repair. This involves removing
any scar tissue from the defect and placing some bone graft in the area followed by placement of
screws across the defect.
If there are symptoms in the legs the surgery may include
a decompression to
create more room for the exiting nerve roots. This is often combined with a
fusion that may be performed either with or without screws to hold the bone
together. In some cases the vertebrae are moved back to the normal position
prior to performing the fusion, and in others the vertebrae are fused where they
are after the slip. There is some increased risk of injury to the nerve with
moving the vertebra back to the normal position.
Next: Can spondylolisthesis be prevented? »
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