Do I Need Spondylolisthesis Surgery?}

Submitted by: Patrick Foote

Spondylolisthesis surgery is a concern for many of the individuals who are diagnosed with this condition. You are certainly not alone in wondering whether you will eventually be left with a large scar and limited mobility in your lower back. However, the reality is that the majority of those who are diagnosed with low-grade spondylolisthesis will be able to manage their symptoms without the need for surgery. Even if you are among the minority who receives little to no relief from conservative treatment, you may still be able to avoid an open spine surgery thanks to new endoscopic techniques.

What is Spondylolisthesis, Anyway?

Though the name spondylolisthesis sounds intimidating, the condition is actually quite easy to understand. Essentially, spondylolisthesis occurs when a vertebra (one of the bone structures that houses and protects the spinal cord) slips forward and over the vertebra located directly beneath it. The extent to which the affected vertebra has slipped out of place plays a large part in determining which treatments will likely provide relief.

Spondylolisthesis is measured in terms of grades, which identify the extent to which a vertebra has slipped out of place:

Grade 1 Up to 25 percent slippage

Grade 2 25 to 50 percent slippage

Grade 3 50 to 75 percent slippage

Grade 4 75 to 100 percent slippage

Grade 5 100 percent slippage

Spondylolisthesis can have many different causes, chief among them the natural aging process. As we grow older, our spines begin to deteriorate because of the wear that is continually placed on them. As different anatomical components break down, the spine can become less adept at supporting body weight and facilitating movement. Without proper support and stability, vertebrae are at risk for slipping out of place, especially when the facet joints are arthritic or the intervertebral discs are dry and brittle.

What Does it Feel Like to Have Spondylolisthesis?

Each of the different spondylolisthesis grades has a different set of symptoms associated with it. In the case of Grade 1 spondylolisthesis, many patients experience no symptoms at all and remain unaware that theyre even suffering from a spinal condition. Those with Grade 2 spondylolisthesis may experience mild to moderate pain, numbness, and muscle weakness that radiates into the hips, buttocks, legs, and/or feet. Grades 1 and 2 are collectively known as low-grade spondylolisthesis and many patients are able to manage their symptoms without spondylolisthesis surgery.

High-grade spondylolisthesis (between 50 and 100 percent slippage) typically causes symptoms that are exponentially more severe than those caused by low-grade spondylolisthesis. Those who have Grade 3 spondylolisthesis will likely experience intense pain, numbness, and muscle weakness, as well as a stiffened back and tightened hamstrings. Grade 4 spondylolisthesis causes significant, often debilitating pain and discomfort and many patients who suffer from this degree of vertebral slippage will have an altered gait that resembles a waddle. Grade 5, the most severe form of spondylolisthesis, usually interferes with a patients quality of life and can cause physical deformities and neurological abnormalities.

How is Spondylolisthesis Treated?

Those who suffer from high-grade spondylolisthesis will more than likely require surgical treatment. In contrast, most of those with up to 50 percent vertebral slippage will be able to treat their symptoms with conservative, nonsurgical techniques. In the case of this and other spinal conditions, it is of the utmost importance that patients work closely with their physicians to develop a treatment regimen that is appropriate for them. While one treatment may relieve one patients symptoms, it may cause further disrepair to another patients spine.

If you have low-grade spondylolisthesis, your physician will likely advise you to take certain medications, which will be determined based on the intensity of your pain and the extent to which your symptoms are interfering with your life. Many patients respond well to over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, or analgesics such as acetaminophen. Other patients may need to utilize narcotic pain relievers and/or muscle relaxants to experience relief.

Your physician may also advise you to make certain changes in your lifestyle. Many obese patients experience exacerbated spinal deterioration because of the added strain that is constantly placed on their necks and backs. Losing weight is the obvious antidote to this problem, as having less body weight places less stress on the spine. In addition to losing weight, you may also be advised to quit smoking, reduce alcohol consumption, become more physically active, and improve your posture when walking, sitting, lifting, or even sleeping.

Physical therapy is another treatment that is commonly recommended for patients who have low-grade spondylolisthesis. This typically entails performing strengthening exercises that target the muscles and ligaments in the neck and back in the hopes of creating a stronger support system for the spine. Physical therapists may also employ other techniques, such as:

Transcutaneous electrical nerve stimulation (TENS)

Cryotherapy

Thermotherapy

Massage therapy

Therapeutic ultrasound

And others

Does Low-Grade Spondylolisthesis Ever Require Surgery?

If the conservative treatment plan your physician recommends does not provide adequate relief after several weeks or months, you may need to undergo spondylolisthesis surgery. During an open spine procedure for this condition, the intervertebral disc beneath the affected vertebrae is removed and replaced with a vertebral cage that is filled with bone graft material. This results in the fusion of this particular section of the spine. While spinal fusion can prevent the affected vertebra from slipping out of place again, it also prohibits any movement from occurring in that region. Following an open spine procedure, many patients face a lengthy hospital stay and an arduous rehabilitation. Unfortunately, some patients even experience failed back surgery syndrome (FBSS), or the worsening or continuation of symptoms following surgery.

Some of those who have low-grade spondylolisthesis may be able to undergo a minimally invasive procedure in lieu of open spine surgery. This procedure is performed on an outpatient basis and utilizes an endoscope to access the affected vertebra. Rather than removing an entire intervertebral disc and fusing two vertebral segments together, a minimally invasive procedure entails removing only the portion of the spinal anatomy that is pressing against a spinal nerve and causing discomfort. Since fusion is not needed, patients are able to retain their complete range of motion following their procedures. Many patients recover from minimally invasive spine procedures within a matter of weeks and some even report that their symptoms have abated immediately following the procedure.

What Now?

If youve recently been diagnosed with low-grade spondylolisthesis, you would be best served to remain patient in the coming weeks and months. Work closely with your physician and let him or her know if you suspect a treatment isnt working. While you may be desperate for immediate relief, it may be necessary to try several different treatment methods before surgery will become an option. If you are one of those who end up needing low-grade spondylolisthesis surgery, be sure to ask your physician if you would qualify for a minimally invasive procedure instead. You may also benefit from receiving a second opinion to ensure that youve been properly diagnosed and that all nonsurgical treatments have been exhausted.

About the Author: Patrick Foote is the Director of eBusiness at Laser Spine Institute, the leader in endoscopic spine surgery. Laser Spine Institute specializes in safe and effective outpatient procedures for the treatment of

spondylolisthesis

and several other spinal conditions.

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