Let’s start this article with the understanding that for many patients diagnosed with spondylolysis and low-grade (typically grade 1) spondylolisthesis, their back pain and functional challenges do not require surgery, their condition can improve with nonsurgical treatment.
If you have been diagnosed with spondylolysis or are the parent of a child with spondylolysis, you have probably had nonsurgical treatments that may have or still include:
- Rest and avoiding activities that worsen your pain or places high stress on your low back.
- Nonsteroidal anti-inflammatory drugs (NSAIDs).
- Physical therapy.
- Back Braces.
Spondylolysis is a crack or fracture in the back of the vertebrae body occurring in the pars interarticularis, the “tail” of the vertebrae. In younger patients this injury can occur from a trauma injury or in older patients degenerative wear and tear. This injury can result in spinal instability and slippage, not of the disc, but the vertebrae itself instability. This is the diagnosis of spondylolisthesis. Spondylolisthesis can be treated non-surgically. Traditional conservative care options include painkillers, activity modification, and possibly the use of corticosteroid injections. However, if bladder, bowel function, or leg weakness or loss of function occurs, surgery will be recommended.
In children and adolescents diagnosed spondylosis is most commonly the L5/S1 segment. In adults, lumbar spondylolisthesis is not always symptomatic. It occurs most frequently at the L4/L5 segment. Adults with degenerative spondylolisthesis will usually not progress to a worsening spondylolisthesis.
Diagnosis
Doctors will suspect spondylosis / spondylolisthesis if the patient describes an injury or trauma recently or even in the past. The patient may describe a situation of being able to relive their back pain by simply leaning forward, walking up stairs, or sitting with a good posture. Doctors will suspect spondylosis / spondylolisthesis if the patient describes pain radiating through the buttocks into the hips and legs.
Lumbar Surgery
A May 2022 study (1) notes that: “Lumbar spinal fusion surgery is a widely accepted surgical treatment in degenerative causes of lumbar spondylolisthesis. The benefit of reduction (correcting) of anterior displacement (the vertebrae is moving forward over the vertebrae beneath it) and restoration of sagittal parameters (the correct curve of the lumbar spine) is still controversially debated.” Better outcomes, the authors write, can be gained from restoring the lumbar spinal curve.
The fusion of the lumbar spine may lead to the degeneration of the adjacent segments.
An April 2022 study (2) examined the effects of Oblique Lateral Interbody Fusion (OLIF) Surgery (considered less invasive and preserving of more spinal motion after surgery) and TLIF Transforaminal Lumbar Interbody Fusion (TLIF) on adjacent the adjacent spinal segments after treatment of L4 degenerative lumbar spondylolisthesis.
At the last follow-up amongst patients in the two groups, there Adjacent Segment Disease in the OLIF group at 2.78% and 5.56% in the TLIF group. The conclusion of this study was: “L4 degenerative lumbar spondylolisthesis after OLIF and TLIF treatment will cause adjacent segment degeneration, and L3-4 degeneration is more obvious than L5-S1 degeneration. OLIF has more advantages in restoring lumbar sagittal balance (corrected lumbar curve). Compared with TLIF, OLIF can weaken the degeneration of the L5-S1 disc and increase the degeneration of the L5-S1 zygapophyseal joints.
References
1 Lenz M, Oikonomidis S, Hartwig R, Gramse R, Meyer C, Scheyerer MJ, Hofstetter C, Eysel P, Bredow J. Clinical outcome after lumbar spinal fusion surgery in degenerative spondylolisthesis: a 3-year follow-up. Archives of Orthopaedic and Trauma Surgery. 2020 Dec 29:1-7.
2 Li GQ, Tong T, Wang LF. Comparative analysis of the effects of OLIF and TLIF on adjacent segments after treatment of L4 degenerative lumbar spondylolisthesis. Journal of orthopaedic surgery and research. 2022 Dec;17(1):1-9.
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