Treatment for Spondylolisthesis

Treatment for Spondylolisthesis

In this article we will analyze the full range of surgical and non-surgical treatment options for spondylolisthesis.

Degenerative spondylolisthesis is relatively rare in other segments of the spine, but can occur in two or even three segments simultaneously.

Each segment of the spine consists of vertebrae, intervertebral discs, and joint facets. The intervertebral disc acts as a shock absorber between the vertebrae, while the paired articular facets restrict movement. They allow the spine to bend forward (flexion) and backward (extension), but do not allow a rotational movement.

As you age, joint facets can become incompetent and allow for too much flexion, allowing one vertebral body to slide on the other.


  1. Changing daily activities
  2. Chiropractic therapy
  3. Epidural injections


Changing daily activities

Patients can change their activities so that they spend more time sitting in a chair and less time standing or walking.

The change in activities generally includes:

  • A short period of rest (for example, one to two days of rest or relaxation in a folding chair);
  • Avoiding standing;
  • Avoiding walking for long periods of time;
  • Avoiding dangerous physical exercises;
  • Avoid activities that require column extension.


If changing activities substantially reduces the patient’s pain and symptoms, this is an acceptable way to manage the condition in the long run.

Applying cold compresses, applying heat or pain medications can help with this approach, especially after walking or any strenuous activity, but it does not solve the problem of long-term pain 100%. For patients who want to be more active, the fixed bike in the gyms is a reasonable option, because it is an activity performed in a sitting position and should be tolerated.

Another option is aqua gym – gymnastics performed in the swimming pool with warm water – because the water provides support and buoyancy, and the patient is comfortable to perform flexion-extension movements to strengthen the lumbar muscles.

Many patients benefit from a physical therapy program in which certain exercises are performed gradually and controlled, which have the role of strengthening the lumbar muscles in order to maintain and / or increase the degree of mobility and flexibility, which, in turn, tends to to alleviate pain as well as to help the patient maintain his ability to function actively every day.


Chiropractic therapy

Chiropractic therapy helps you to reduce pain by mobilizing painful joint dysfunction. The first symptom identified by the chiropractor in case of spondylolisthesis is pain in the affected region. It improves in flexion, and is accentuated in extension, this posture favoring the degree of sliding.

The contracture of the paravertebral muscles is present, to which the contracture of the gluteal muscles can be associated, respectively the contracture of the thigh muscles. Slipping can also lead to compression of the roots of the spinal nerves, in which case symptoms such as numbness, tingling, loss of reflexes, even muscle atrophy along the path of the affected nerves may occur.

The treatment of spondylolisthesis aims to align the slippery vertebrae, which will remove pain and muscle contractions, and stop the negative effects on the limbs through which the pressed nerve passes (numbness, tingling, muscle atrophy), thus ensuring the patient’s return to daily activities.

These results can be obtained by chiropractic, a method successfully used in the treatment of spondylolisthesis, which consists of various manipulations performed on the spine by elongation, torsion and cracking.

Through these manipulations, after several sessions, the slipped vertebra is progressively repositioned, resulting in the disappearance of the mentioned symptoms in a relatively short time, acting directly because of these symptoms.


Epidural injections

Injections are effective in reducing a patient’s pain in up to 50% of cases.
An epidural injection of steroids works to relieve the patient’s pain and can be done a maximum of three times a year. The length of time the lumbar epidural injection can be effective is variable, as pain relief can take a week or a year.


Spondylolisthesis: causes, symptoms, treatment

Spondylolisthesis is the anterior slip of one vertebra to the rest of the vertebrae, more precisely the vertebra changes its initial position and leaves the alignment of the other adjacent vertebrae.

Spondylolisthesis is classified according to the causes of its occurrence and is of five types: congenital, isthmic, degenerative, traumatic and pathological.



  1. Causes of Spondylolisthesis
  2. Symptoms of Spondylolisthesis
  3. Treatment of Spondylolisthesis



  • congenital defect in the spine (usually occurs a few years after birth);
  • acute trauma to the back;
  • exaggerated repetitive extensions (common in certain sports);
  • muscle atrophies;
  • degenerative diseases of the spine.



Other people suffer from pain, especially under stress and during certain movements. The pain caused by spondylolisthesis can spread from back to front in a belt shape. There is also a feeling of instability in the spine.

Especially in the morning, when the back muscles are relaxed, the pain is strong. In severe cases, there are reflex, sensory and motor disorders, which can extend to the legs. These symptoms occur when the vertebra squeezes a nerve root through a spondylolisthesis.

However, there are no specific gliding symptoms, as the symptoms may be similar to those of other back problems, such as herniated discs.

In the congenital form of patients with spondylolisthesis, usually the symptoms are mild or mild, being a slow progressive process. So the nerves have the opportunity to adapt to changed circumstances.



Physical and rehabilitation therapy
It should not be initiated until after a period of rest and once the pain with daily activities has diminished. Physical regimens reduce the stress by extension of the lumbar spine and promote a nonlordotic position. It consists of exercises for stretching the abdominal muscles, wearing harnesses and strengthening the lumbodorsal fascia.

Thoracolombosacral orthosis trimming provides relief for those who do not respond to rest or whose daily activities cause symptoms. This type of rod is effective for patients with less than 50% slip. The stem is worn for 3-6 months. If the slip is below 50% but the patient is symptomatic, non-interventional therapy is recommended: stretching exercises, antilordotic rod, modification of activities. If the pain continues, spinal fusion is recommended.

Surgical therapy
Surgery is indicated for immature skeletal patients with slipping over 30-50% because they are at risk of progression with neurological deficit and persistent pain. If the pain does not resolve in 6-12 weeks with rest and immobilization, surgery is recommended. Spondylolysis with low-grade spondylolisthesis can be treated noninterventionally.

Intervention options include direct repair of spondylolytic defect, fusion, reduction and fusion, and vertebrectomy. The best results are seen in patients with lithic defect. Disc degeneration is a relative contraindication. Slips over 2 mm decrease the success of surgical repair.

In situ fusion at the affected level is the standard criterion for surgical treatment for most patients in whom conservative therapy fails. In situ fusion is recommended for patients with low-grade, persistent, symptomatic spondylolisthesis and for those who are not candidates to repair the defect.

Decompression and fusion are performed in cases of hard compression in the presence of intestinal or bladder dysfunction or significant motor deficits. Decompression is never performed without concomitant fusion. Fixing the pedicles with screws allows rapid mobilization and early ambulance after decompression and fusion. Fixation can be beneficial in repairing pseudoarthrosis and preventing progressive slipping.

The reduction of spondylolisthesis is performed by the closed or open procedure. The reduction serves to correct the lumbosacral kyphosis and decrease the sagittal translation. Vertebrectomy can be used to treat spondyloptosis and as an alternative to reduction or fusion in situ. The postoperative rate of neurological deficit is 25%