Degenerative Spondylolisthesis: What is it and How is it Treated?
Usually affecting the lower (lumbar) part of the spinal column, degenerative spondylolisthesis describes a vertebra which has slipped forward, protruding over the one below it.
A consequence of aging, this condition results when the systems of the spine are weakened over time and become less able to maintain proper alignment.
Relatively rare at other levels of the spine, degenerative spondylolisthesis occurs more in people over 50. But people over 65 are most susceptible. Also, women are more likely to develop it than men, at a rate of 3 to 1.
The good news is that because degenerative spondylolisthesis almost always attacks the lumbar spine, there is no spinal cord to compromise (as it’s not present in the lumbar region). So even when patients are experiencing serious pain, there’s no possibility of damage to the spinal cord.
There are 4 broad categories of treatment models applied to degenerative spondylolisthesis. Let’s review them:
Modification of activity
Spending more time sitting and less moving around is one of the recommendations for people experiencing the pain from this condition. Doctors will usually recommend that patients rest for 1 or 2 days, either in bed on in a chair that reclines.
Patients are also asked to avoid standing or walking for prolonged periods. Any exercise or activities that require bending backwards are also prohibited.
Manipulation of the affected area by a chiropractor, osteopath, physiatrist or other licensed clinician reduces pain through mobilization. Mobilization joins prevents stiffness, which can make pain much worse.
Patients experiencing extreme pain, including in the lower extremities are often prescribed epidural injections of steroids.
The injection of steroids is highly effective for pain relief and is responsible for improving function in 50% of cases.
When successful for the patient, a course of injections may be followed over a year but only with 3 unique injections.
Pain relief is variable from patient to patient, with some experiencing only 1 week of relief and others, an entire year.
Surgery is a last resort and only rarely deployed for cases of degenerative spondylolisthesis. Most patients manage symptoms effectively without resort to surgery.
When pain has become insupportable, disabling the patient, surgery may be considered. Surgery is also considered in the rare event of neurologic decline.
Surgery in the case of this condition relieves pressure on impinged nerves and stabilizes the area of concern.
For degenerative spondylolisthesis, surgery is conducted in two parts, with the first part being laminectomy (decompression) and the second being spinal fusion using the pedicle screw.
Due to the spinal instability in play, the second part of the surgery is necessary in order to provide the patient with long term stability. In a 10 year follow up study, patients undergoing the 2-part surgery saw much better results.
Spine Consult NJ
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As our name reveals, we’re a group of clinicians who treat all conditions of the spine. Contact us about degenerative spondylolisthesis and treatment.