When Is Surgery the Best Option for Spondylolisthesis?

If you’re part of the 4%-6% of the adult population with spondylolisthesis, you’re all too familiar with the significant pain and discomfort it can cause. This spinal condition occurs when one vertebra slips out of place and over the one below it. 

For many patients, conservative treatments such as physical therapy, medication, and lifestyle modifications provide adequate relief. But if these treatments aren’t providing you with relief, our team at Alabama Neurological Surgery & Spine in Birmingham, Alabama, may recommend surgery as the most effective and necessary option. 

Here, we describe various treatments for spondylolisthesis and explain when surgery may be your best option.

Understanding spondylolisthesis

Spondylolisthesis can occur due to various reasons, including congenital defects, trauma, degenerative changes, or stress fractures. Symptoms often include lower back pain, leg pain, numbness, and weakness. In severe cases, it can lead to significant disability and impair your daily activities.

Conservative treatments

Before considering surgery, we typically recommend conservative treatments. These may include:

• Physical therapy that involves strengthening and stabilizing exercises for your back and core muscles
• Medications like nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and inflammation
• Activity modifications to avoid actions that make symptoms worse
• A physical brace to provide external support to the spine
• Epidural steroid injections, which reduce inflammation around the spine

While these treatments are effective in many cases, they may not work for you. If they don’t bring you relief, or your condition worsens, we may recommend surgery.

Additional indications for surgery

We also typically  recommend surgery for spondylolisthesis in the following cases:

1. Persistent pain and disability

Spondylolisthesis can lead to chronic pain and disability that significantly impacts your overall quality of life. Persistent pain that limits daily activities, disrupts sleep, or affects mental well-being indicates the need for surgical intervention.

2. Neurological symptoms

If your spondylolisthesis results in nerve compression, it will cause symptoms such as severe leg pain, numbness, tingling, or weakness. Surgery may be necessary to relieve pressure on the affected nerves. Progressive neurological deficits, such as worsening weakness or loss of bladder or bowel control, are urgent indicators for surgery.

3. High-grade slippage

Spondylolisthesis is classified into grades based on the degree of vertebral slippage. High-grade slips (Grade III and above) are more likely to cause significant symptoms and spinal instability, often requiring surgical correction to prevent further slippage and complications.

What surgery for spondylolisthesis is like

We offer several different types of surgery to address the symptoms of spondylolisthesis. The choice of procedure depends on the severity of the condition and your specific needs. 

Spinal fusion is the most common surgical treatment for spondylolisthesis. It involves joining two or more vertebrae to prevent movement at the affected segment, providing stability and alleviating pain. 

Another option is a laminectomy, which involves removing part of the vertebral bone (the lamina) to relieve pressure on the spinal nerves. We often combine this procedure with spinal fusion to ensure stability.

We may also consider decompression surgery to alleviate nerve compression by removing bony overgrowths or herniated disc material. This procedure can significantly reduce pain and improve neurological symptoms.

Recovery from surgery for spondylolisthesis

Recovery from spondylolisthesis surgery varies depending on the type of procedure and your personal health, age, and activity level. Generally, you can expect a gradual return to normal activities over several months, with physical therapy playing an essential role in rehabilitation.

Most patients experience significant pain relief, improved function, and enhanced quality of life following surgery.

If you or a loved one is struggling with spondylolisthesis, contact Alabama Neurological Surgery & Spine to make an appointment. Our team of experts deliver personalized care and advanced surgical solutions for spondylolisthesis.