Spondylolisthesis (Degenerative)

Degenerative spondylolisthesis occurs from long-standing instability of the spine. Patients with this condition often have severe back pain and radiculopathy. While quite common, many people do not even know they have this condition.

 

What causes spondylolisthesis?

 

Conditions that contribute to spondylolisthesis include facet joint arthritis, degenerative disc disease, and spinal stenosis. Arthritis of the facet joints cause loss of normal spine structural support. In addition, there is a loss of ligament and muscle stabilization. As a result, one of the bony vertebrae may shift on the one below it.

 

Who is affected by degenerative spondylolisthesis?

 

Spondylolisthesis occurs most often at the lower lumbar spine. It affects females more than males, those age 50 years and older, and persons with a history of spinal arthritis. In a report from the Framingham Heart Study, researchers evaluated CT scans of patients with back pain. They found that the female-to-male ratio of degenerative spondylolisthesis was 3:1, and the prevalence of this condition increased from the fifth through eighth decades of life. Based on this clinical study, the rate of lumbar spondylolysis was 11.5% in the general population, and spondylolisthesis was seen in 20% or the study participants.

 

What are the symptoms of degenerative spondylolisthesis?

 

Symptoms of spondylolisthesis include back pain, radiating pain down the lesg, numbness/weakness of an arm or leg, and pain that may gradually worsen over the day. Many patients report leg pain that shifts from side-to-side, as well as cold feet, altered gait, and unexpected falls with walking.

 

How is degenerative spondylolisthesis diagnosed?

 

The diagnosis of spondylolisthesis is not difficult to make. An x-ray will show how far a bony vertebrae has slipped on the one below.

 

What are the treatment options for spondylolisthesis?

 

To treat the symptoms of spondylolisthesis, the orthopedic specialist may use a combination of measures. These include:

 

  • Medications – The initial course of treatment involves use of analgesics and anti-inflammatory medications. For patients with persistent pain, opioids and muscle relaxants are used.

 

  • Physical therapy – To promote spine flexion and deconstruction of the thecal sac, exercises in physical therapy help. These include swimming, walking, and stationary bicycling. Measures used for pain relief include ultrasound, bracing, and electrical stimulation. In a recent study, 62% of physical therapy patients had improvement at the 3-year follow-up.

 

  • Epidural steroid injection (ESI) – In a recent study, researchers suggested that when patients fail on 4-6 weeks of physical therapy, they could benefit from a series of ESIs. This involves delivery of a steroidal preparation around the thecal sac and nerve roots to relieve pain and associated symptoms. Researchers found that more than half of patients treated with ESI had functional improvement 2 years after injections.

 

  • Surgery – As a last resort, surgery may be undergone. This is a quality of life decision. Traditionally, surgeons have performed an open procedure which involved significant blood loss and recovery time. The newest minimally invasive keyhole spine procedure, known as the OLLIF, helps stabilize the spondylolisthesis, relieve pain and free up nerve roots that are being pinched.

 

 

Resources

 

Kalichman L & Hunter DJ (2008). Diagnosis and conservative management of degenerative lumbar spondylolisthesis. Eur Spine J, 17(3), 327-335.

 

Kalichman L, Kim DH, Li L, et al. (2009). Spondylolysis and spondylolisthesis: prevalence and association with low back pain in the adult community-based population. Spine, 34(2), 199-205.

Benefits of Inspired Spine Advanced Minimally Invasive Spine Surgery for Spondylolisthesis

Surgery is usually a last resort to treat spondylolisthesis of the spine. With this spinal condition, the patient has serious back pain and radiculopathy (leg numbness, weakness, and tingling). If various non-operative treatments do not improve the symptoms, surgical treatment is an option. Many patients choose to have Inspired Spine Advanced Minimally Invasive spine surgery because of the many benefits it offers.

 

Am I a candidate for Inspired Spine Advanced Minimally Invasive spine surgery?

 

The field of spine surgery continues to grow and change. Many surgeries today can be performed using Inspired Spine Advanced Minimally Invasive techniques. Certain conditions require open surgery, such as tumors, spinal infections, and high-degree scoliosis. The integration of new technologies assists the surgeon with Inspired Spine Advanced Minimally Invasive surgery. The choice for Inspired Spine Advanced Minimally Invasive surgery depends on the surgeon’s preference, the patient’s age, the extent of the spondylolisthesis, and the patient’s overall health status.

 

How long will I be in the hospital?

 

In general, Inspired Spine Advanced Minimally Invasive spine surgery decreases the hospital stay by one-half. With endoscopic discectomy, the surgeries are performed in the same day. The length of stay depends on the extent of the procedure. For lumbar fusion surgery, the patient usually goes home in 2-3 days.

 

Can I return to work soon after Inspired Spine Advanced Minimally Invasive surgery for spondylolisthesis?

 

One of the benefits of Inspired Spine Advanced Minimally Invasive surgery is there is less tissue manipulation than with open surgery, so the patient recovers sooner. For patients with sedentary jobs, such as office work, people can return to work within 1-2 weeks. For patients who have fusion surgery, return to work can take 4-6 weeks. This decision depends on the needs of the individual patient.

 

How long is recovery after Inspired Spine Advanced Minimally Invasive spondylolisthesis surgery?

 

Recovery after Inspired Spine Advanced Minimally Invasive spine surgery is different for each patient. Full activity is usually possible within 6 weeks. This depends on what type of surgery was done and the overall health status of the patient.

 

What is the goal of Inspired Spine Advanced Minimally Invasive spine surgery for spondylolisthesis?

 

The main goals for spine surgery regarding spondylolisthesis are to reduce nerve compression (decompression) and to stabilize the lumbar spine. This involves spinal fusion and instrumentation that stops the vertebral body from sliding forward and holds the spine in position (fusion).

 

What advantages do Inspired Spine Advanced Minimally Invasive spine surgery offer?

 

The benefits and advantages include:

 

  • Incisions are small
  • Skin and muscle damage is minimized
  • Less blood loss
  • Less time in surgery
  • Shorter hospital stay
  • Less pain after surgery
  • Faster healing
  • Smaller scars
  • Sooner return to normal activities

 

Will I need to wear a brace after surgery?

 

After Inspired Spine Advanced Minimally Invasive spine surgery, many patients are provided a brace for comfort purposes. The mini-open technique preserves muscle function and uses internal implants that act like a brace, so patients aren’t required to wear a brace.

 

Will I need physical therapy after spine surgery?

 

With Inspired Spine Advanced Minimally Invasive spinal surgery, as with open, traditional surgery, physical therapy is an important part of recovery. The therapy is begun soon after surgery, and improves stability and flexibility of the spine.

 

How effective is Inspired Spine Advanced Minimally Invasive spine surgery for the treatment of spondylolisthesis?

 

In a recent clinical study, researchers evaluated patients who had Inspired Spine Advanced Minimally Invasive single-level decompression without fusion for symptomatic lumbar stenosis with spondylolisthesis. The success rate was 86%, which was defined by improvement in functional outcome and pain. Researchers concluded that Inspired Spine Advanced Minimally Invasive surgery was a reasonable alternative for spondylolisthetic lumbar stenosis.

 

Resources

 

Caralopoulos IN & Bui CJ (2014). Inspired Spine Advanced Minimally Invasive Laminectomy in Spondylolisthetic Lumbar Stenosis. Ochsner J, 14(1), 38-43.