For those individuals who have diagnosed spondylolisthesis and have unsuccessfully attempted non-surgical treatment options, surgery may be the best course of action. Due to technological advances in spine surgery procedures, spondylolisthesis can now be treated with a minimally invasive fusion surgery – allowing for reduced operation-related issues in addition to other benefits.
How is spondylolisthesis diagnosed?
The first step in diagnosing spondylolisthesis is a physical exam. Difficulty lifting your leg straight forward may be an indication of spondylolisthesis. X-ray images must be taken of the lower back in order for your surgeon to determine whether a vertebra has slipped out of place.
If the x-ray is suggestive of spondylolisthesis, an MRI or CT-scan will likely be ordered to ascertain which, if any, nerves are being compressed by the vertebra in question. An MRI can also provide a clearer visualization of the slipped vertebra as well as any other structures that may be involved.
Why seek treatment for spondylolisthesis?
If left untreated, spondylolisthesis can cause a number of complications and a substantial reduction in quality of life. Chronic radicular pain and stiffness, and the consequent reduction in mobility, often results in individuals being substantially less active. This increased inactivity can lead to myriad other complications as muscles can weaken and atrophy, bones can become less dense, and flexibility is progressively lost. In some cases, spondylolisthesis-caused inactivity can result in an individual becoming overweight, rendering them vulnerable to a number of other potential health complications. For these reasons, it is imperative that spondylolisthesis be properly diagnosed and treated in a timely fashion.
Once spondylolisthesis has been positively diagnosed, a grade is assigned to describe the percentage of slippage that has occurred.
What are the non-surgical treatment options for spondylolisthesis?
The best course of treatment is dependent on both the severity of the spondylolisthesis and the condition and circumstances of the individual being treated. As such, your treatment plan will need to be personalized to you specifically in order to most effectively alleviate your symptoms and increase your quality of life.
In most cases, spondylolisthesis can be successfully treated without the use of surgical intervention. Conservative treatment of spondylolisthesis usually involves a combination of rest and physical therapy. Low-impact activities such as swimming and yoga are often advised to help strengthen the core and improve flexibility. Additionally, pain medications, steroid injections, and hot and cold therapy may be prescribed to help alleviate symptoms noninvasively.
What if conservative treatments do not provide enough relief?
Spondylolisthesis is not a self-resolving condition which means that symptoms will not typically subside until an effective treatment is carried out. For those patients whose symptoms are not eliminated by means of physical therapy or other non-surgical treatments, surgery may be advised as the next step in treatment. Fortunately, spondylolisthesis is highly treatable and the vast majority of cases are able to be successfully resolved.
Why choose minimally invasive surgery over open surgery?
While decompression and fusion surgeries can be completed using traditional open surgery, minimally invasive surgery offers a number of advantages over conventional methods.
Open spinal fusion surgery requires long incisions and substantial disruption to surrounding musculature and other tissues. As a result, the surgery takes a long time and requires hospitalization. Recovery is often lengthy and painful. Additionally, the risk of infection and other complications – including a worsening of symptoms – is higher with open surgery.
Minimally invasive procedures use smaller incisions and follow natural pathways in the body. Consequently, damage to surrounding tissue is mostly eliminated and operation-related pain and scarring are significantly reduced.
How is minimally invasive spondylolisthesis surgery performed?
The spine is comprised of small bones known as vertebrae that are stacked on top of each other –separated by discs – along the length of your neck and back. This S-shaped column of discs and vertebrae is supported by surrounding muscles and ligaments, as well as facet joints and cartilage. The spinal column facilitates flexible mobility necessary for daily living while also serving to protect the complex and sensitive nerves that run through it. Spondylolisthesis occurs when a vertebra becomes dislocated causing the spine to become misaligned. In many cases, the vertebra or other tissue e.g. facet joint, disc can apply pressure to a nerve, causing pain numness and other potential symptoms.
Generally speaking, spondylolisthesis surgery involves two main steps: decompression and stabilization. Decompression is achieved by removing any extraneous tissues that are applying pressure to a nerve root or the spinal cord.
Stabilization involves the surgeon moving the slipped vertebra back into place and securing it using implants – this is known as fusion surgery. Typically, bone grafts are used to help the live bones healing it fuses the target vertebra to the rest of the spine. Rods or screws may also be inserted at the time of surgery to ensure that the vertebra stays in the desired location while the bone graft sets.
Minimally invasive spondylolisthesis surgery was conceived to provide a less invasive, gentler fusion surgery alternative to open surgery. In this type of procedure, surgeons make very small incisions and insert tools through rigid tubular instruments (tubular retractors) along natural planes in the body.
The surgeon often uses an endoscope to provide a clear video image of the area on which they are working. They use the tools inserted in the tubular retractors to remove any bone, disc, or other tissue that are causing nerve compression. Using a similar process, the surgeon applies the bone graft to the affected vertebra.
In some cases, decompression surgery is performed without fusion, but this is not typically recommended as subsequent fusion surgery is usually required.
What should a potential patient expect before and after surgery?
Minimally invasive spondylolisthesis surgery can be performed on an outpatient basis and patients typically experience a quicker rehabilitation period as compared to conventional surgery.
After surgery, physicians will often prescribe limited activity for a period of time. Within several weeks, physical therapy is usually started to help strengthen the back and stomach muscles. Once the fusion is set, often within several months, the patient will be able to engage in their regular activities. Except in some very severe cases, it is not necessary that a patient’s activities be permanently restricted.
Spinal fusion surgery to treat spondylolisthesis boasts very high success rates, and many patients will not experience a recurrence of their symptoms. However, maintaining a healthy weight, diet, and low-impact exercise routine can help to decrease the chance of subsequent slips.
Are there any risks associated with spondylolisthesis surgery?
When considering any surgery, it is important to thoroughly research and discuss with your physician all possible options and outcomes. There are potential risks associated with any surgical procedure and it is imperative to make sure that you are fully informed when making a decision.
Some risks associated with spondylolisthesis surgery include bleeding, injury to nerve roots or other tissues, and infection. An additional risk is the failure to achieve one or more of the desired outcomes of the surgery – the fusion not taking, inadequately reduced pain, or a hardware failure undermining the support the implanted rods and screws are meant to provide.
Nicotine consumption, excessive weight, and prior failed spine surgery can all increase the likelihood of the above risks. Further, the presence of certain medical conditions such as rheumatoid arthritis, osteoporosis, and diabetes may put an individual at greater risk of experiencing complications. Be sure to tell your physician if any of these risk factors apply to you.