Treatment of Spondylolisthesis Exercise Lifestyle is a condition in which one vertebra slips forward over the one below it. It is a slipping of the vertebra that occurs, in most cases, at the base of the spine. Spondylolysis, which is a defect or fracture of one or both wing-shaped parts of a vertebra, can result in vertebrae slipping backward, forward, or over a bone below
Spondylolisthesis most commonly occurs in the lower lumbar spine but can also occur in the cervical spine and rarely, except for trauma, in the thoracic spine. Degenerative spondylolisthesis predominately occurs in adults and is more common in females than males with increased risk in the obese. Isthmic spondylolisthesis is more common in the adolescent and young adult population but may go unrecognized until symptoms develop in adulthood. There is a higher prevalence of isthmic spondylolisthesis in males. Dysplastic spondylolisthesis is more common in the pediatric population with females more commonly affected than males. Current estimates for prevalence are 6-7% for isthmic spondylolisthesis by the age of 18 years and up to 18% of adult patients undergoing MRI of the lumbar spine. Grade I spondylolisthesis accounts for 75% of all cases. Spondylolisthesis most commonly occurs at the L5-S1 level with anterior translation of the L5 vertebral body on the S1 vertebral body. The L4-5 level is the second most common location for spondylolisthesis.
Spondylolisthesis is where a bone in the spine (vertebra) slips out of position, either forwards or backward.
It’s most common in the lower back (lumbar spine), but it can also occur in the mid to upper back (thoracic spine) or the neck (cervical spine). Spondylolisthesis isn’t the same as a slipped disc, which is where one of the spinal discs between the vertebrae ruptures.
The word spondylolisthesis comes from the Greek words spondylosis, which means “spine” or “vertebra,” and listhesis, which means “to slip or slide
Treatment of Spondylolisthesis
- Rest – Initially, spondylolisthesis treatment includes resting as much as possible. Lying on your back on a firm mattress is typically the most comfortable position. Try to avoid extended periods of sitting. Your doctor may order a brace as a spondylolisthesis treatment to limit movement in your spine.
- Avoid strenuous activity – This includes avoiding bending and lifting and avoiding prolonged standing.
- Apply ice and/or heat – At first, ice can be helpful to relieve the initial inflammation as a treatment for spondylolisthesis. Apply an ice pack wrapped in a thin T-shirt or towel to your back for about 20 minutes several times daily. If you don’t have an ice pack, use a bag of frozen vegetables. Heat relaxes muscles spasms and increases blood flow to injured tissues. Use the low or medium setting on a heating pad, or try a steamy shower. Sometimes alternating heat and cold applications is an effective spondylolisthesis treatment to help relieve pain.
- Alternative spondylolisthesis treatments – Acupuncture or acupressure helps relieve spondylolisthesis pain for some patients. Some people also find chiropractic care to be an effective alternative spondylolisthesis treatment. If you try an alternative therapy, be sure to find practitioners who are skilled in the treatment of spondylolisthesis.
- Bracing – Some patients may need to wear a back brace for a period of time to limit movement in the spine and provide an opportunity for a recent pars fracture to heal. We did not find any studies that specifically evaluated brace treatment for symptoms associated with DS. However, Prateepavanich et al. [Rx] evaluated the effectiveness of a lumbosacral corset in a self-controlled comparative study on 21 patients (mean age 62.5) with symptomatic degenerative lumbar spinal stenosis (neurogenic claudication). Patients treated with the corset showed a statistically significant improvement in walking distance and decrement of pain score in daily activities in comparison with patients who did not wear the corset. Because most patients with symptomatic DS suffer from neurogenic claudication, the use of bracing needs to be examined for the treatment of patients with DS.
- Physiotherapy – Stabilization exercises are the mainstay of treatment. These exercises strengthen the abdominal and/or back muscles, minimizing bony movement of the spine. Generally, eight to 12 weeks of aggressive daily treatment with stabilization exercises are needed to achieve clinical improvement. is the most common method used to apply a non-operative the treatment of symptoms associated with DS? Therapeutic protocols may include the use of modalities for pain relief, bracing, exercise, ultrasound, electrical stimulation, and activity modification [ Rx]. Unfortunately, some of the evidence for the effects the of physical rehabilitation methods are coming from case reports [ Rx] and cannot be generalized to the rest of the population. Physiotherapy treatment is recommended to reduce pain [Rx], to restore range of motion and function, and to strengthen and stabilize the spine [Rx] and restore mobility of the neural tissue [Rx].
- Flexion/extension Physiotherapy – is the most common method used to apply a non-operative treatment of symptoms associated with DS. Therapeutic protocols may include the use of modalities for pain relief, bracing, exercise, ultrasound, electrical stimulation, and activity modification [Rx]. Unfortunately, some of the evidence for the effectiveness of physical rehabilitation methods are coming from case reports [Rx] and cannot be generalized to the rest of the population. Physiotherapy treatment is recommended to reduce pain [Rx], to restore range of motion and function, and to strengthen and stabilize the spine [ Rx] and restore mobility of the neural tissue [Rx]. Extension strengthening exercises. Those doing flexion and those doing extension back strengthening exercises. All patients received instructions on posture, lifting techniques, and the use of heat for relief of symptoms. After 3 months, only 27% of patients who were instructed inflection exercises had moderate or severe pain and only 32% were unable to work or had limited their work.
- Stabilization exercises – O’Sullivan et al. [Rx] found that individuals with chronic LBP and a radiological diagnosis of spondylolysis or spondylolisthesis who underwent a 10-week specific exercise treatment program involving the specific training of the deep abdominal muscles, with co-activation of the lumbar multifidus proximal to the pars defects showed a statistically significant reduction in pain intensity and functional disability levels, which was maintained at 30-month follow-up. The control group that received treatment as directed by their treating practitioner showed no significant change in these parameters after intervention or at follow-up. Lindgren et al. [Rx] found that exercise therapy in patients with chronic low back pain and segmental instability symptoms can improve strength and electromyographic parameters of paraspinal muscles, but not change the radiographic signs of instability.
- Combined treatment – As we mentioned before, symptoms associated with spinal stenosis have main complained of patients with DS. Simotas et al. [Rx] report on a case series of 49 patients treated non-operatively for spinal stenosis. In addition to pharmacologic intervention that may have included oral analgesics and ESI, the intervention consisted of therapeutic exercise (postural instruction, lumbopelvic mobilization exercises, and a flexion-based exercise program). After 3 years, nine of 49 patients (18%) had surgical intervention. Five patients (10%) reported their condition to be worse, and the remaining 35 patients (71%) either reported no deterioration in their condition or reported improvement (slight or sustained). The authors conclude that aggressive nonoperative treatment for spinal stenosis remains a reasonable option.
- Spinal manipulation – Spinal manipulation is an alternative treatment often pursued by patients. No randomized clinical trials of patients with spondylolisthesis or spinal stenosis have been done. We found only one study [Rx] that evaluated the effectiveness of spinal manipulative therapy for LBP by comparing two groups of patients: a small group (25) of patients with lumbar spondylolisthesis and a larger group (260) of patients without spondylolisthesis. This study showed that the results of manipulative treatment are not significantly different in patients with or without lumbar spondylolisthesis. Patients may have some short-term pain relief from chiropractic manipulation, but no long-term benefit has been proven.
- Conservative treatment — The person should take a break from sports and other activities until the pain subsides. An over-the-counter non-steroidal anti-inflammatory drug (NSAID), such as ibuprofen or naproxen might be recommended to help reduce pain and inflammation (irritation and swelling). Stronger medications might be prescribed if the NSAIDs do not provide relief. Epidural steroid injections — in which medication is placed directly in the space surrounding the spine — might also help reduce inflammation and ease the pain.
- A brace or back support – might be used to help stabilize the lower back and reduce pain. A program of exercise and/or physical therapy will help increase pain-free movement, and improve flexibility and muscle strength. Periodic X-rays are done to determine if the bone slippage is continuing.
- Holistic therapy – Some patients want to try holistic therapies such as acupuncture, acupressure, nutritional supplements, and biofeedback. The effectiveness of these treatments for spondylolysis and spondylolisthesis may aid you in learning coping mechanisms for managing pain as well as improving your overall health.
Medications of Spondylolisthesis
Your first step to treat AS will be taking drugs called nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs help relieve your inflammation, pain, stiffness, and swelling. Still, NSAIDs do not treat the problems with your immune system when you have AS. These problems cause damage to your joints and bones.
- Analgesic medications – are those specifically designed to relieve pain. They include OTC acetaminophen and aspirin, as well as prescription opioids such as codeine, oxycodone, hydrocodone, and morphine. Opioids should be used only for a short period of time and under a physician’s supervision. People can develop a tolerance to opioids and require increasingly higher dosages to achieve the same effect. Opioids can also be addictive. Their side effects can include drowsiness, constipation, decreased reaction time, and impaired judgment. Some specialists are concerned that chronic use of opioids is detrimental to people with back pain because they can aggravate depression, leading to a worsening of the pain.
- Nonsteroidal anti-inflammatory drugs (NSAIDS) – relieve pain and inflammation and include OTC formulations (ibuprofen, ketoprofen, and naproxen sodium). Several others, including a type of NSAID called COX-2 inhibitors, are available only by prescription. Long-term use of NSAIDs has been associated with stomach irritation, ulcers, heartburn, diarrhea, fluid retention, and in rare cases, kidney dysfunction and cardiovascular disease. The longer a person uses NSAIDs the more likely they are to develop side effects. Many other drugs cannot be taken at the same time a person is treated with NSAIDs because they alter the way the body processes or eliminates other medications.
- Anticonvulsants—drugs primarily used to treat seizures—may be useful in treating people with radiculopathy and radicular pain.
- Antidepressants – such as tricyclics and serotonin and norepinephrine reuptake inhibitors have been commonly prescribed for chronic low back pain, but their benefit for nonspecific low back pain is unproven, according to a review of studies assessing their benefit.
- Muscle Relaxants – If the muscles around the slipped disc experience painful spasms, a muscle relaxant such as Valium may be useful. The drawback to drugs like these is that they do not limit their power to the affected nerve. Instead, they have a generally relaxing effect and will interfere with daily activities.
- Such as cyclobenzaprine (Flexeril), might be prescribed to relieve the discomfort associated with muscle spasms. However, these medicines might cause confusion in older people. Depending on the level of pain, prescription pain medicines might be used in the initial period of treatment.
- Steroids – If inflammation is severe, a doctor may also prescribe a steroid. Steroids, such as cortisone, reduce swelling quickly. A cortisone shot directly in the affected area will have an immediate effect on the displaced disc.
- Counter-irritants – such as creams or sprays applied topically stimulate the nerves in the skin to provide feelings of warmth or cold in order to dull the sensation of pain. Topical analgesics reduce inflammation and stimulate blood flow.
- Nerve Relaxant — Pregabalin or gabapentin and anti-inflammatory drugs help to relieve pain and stiffness, allowing for increased mobility and exercise. There are many common over-the-counter medicines called non-steroidal anti-inflammatory drugs (NSAIDs). They include aspirin, ibuprofen (Motrin, Advil), and naproxen (Naprosyn, Aleve).
- Calcium & vitamin D3 – to improve bones health and healing fracture.
- Glucosamine & Diacerein – can be used to tightening the loose tension and regenerate cartilage or inhabit the further degeneration of cartilage.
- Corticosteroid- to healing the nerve inflammation and clotted blood in the joints.
- Dietary supplement -to remove the general weakness & improved the health.
Treatment for spondylolisthesis depends on several factors, including the age and overall health of the person, the extent of the slip, and the severity of the symptoms. Treatment most often is conservative, involving rest, medication, and exercise. More severe spondylolisthesis might require surgery.
Surgery of Spondylolisthesis
- Surgery might be necessary if the vertebra continues to slip or if the pain is not relieved by conservative treatment and begins to interfere with daily activities. The main goals of surgery for spondylolisthesis are to relieve the pain associated with an irritated nerve, to stabilize the spine where the vertebra has slipped out of place, and to increase the person’s ability to function.
- Usually, two surgical procedures are used to treat spondylolisthesis. The first procedure is a decompressive laminectomy, which involves removing the part of the bone that is pressing on the nerves. Although this procedure can reduce pain, removing a piece of bone can leave the spine unstable.
- The second procedure, called spinal fusion, is performed to provide stability. In a fusion, a piece of bone is transplanted to the back of the spine. As the bone heals, it fuses with the spine — creating a solid mass of bone — keeping the spine from moving and stabilizing it. In some cases, instruments such as rods or screws are used to hold the vertebra firm as the fusion heals.
In spondylolisthesis, one of the vertebra in your spine slips forward out of its normal position onto the vertebra below it. This can cause pain and other symptoms. One treatment for this condition is surgical spinal fusion, but non-surgical spondylolisthesis treatments and exercises are also often recommended.
The following exercises are commonly prescribed to patients with this condition. You should discuss the suitability of these exercises with your physiotherapist prior to beginning them. Generally, they should be performed 3 times daily and only provided they do not cause or increase symptoms. Your physiotherapist can advise when it is appropriate to begin the initial exercises and eventually progress to the intermediate, advanced and other exercises. As a general rule, the addition of exercises or progression to more advanced exercises should only take place provided there is no increase in symptoms.
Transversus Abdominus Retraining
Slowly pull your belly button in “away from your belt line” and breathe normally. Your rib cage should remain relaxed and should not elevate during this process. You should be able to feel the muscle contracting if you press deeply 2cm in from the bony process at the front of your pelvis (figure 3). Practice holding this muscle at one-third of a maximal contraction for as long as possible during everyday activity (e.g. when walking etc.) provided it is pain-free. Repeat 3 times daily.
Rotation in Lying
Begin this exercise lying on your back as demonstrated (figure 4). Slowly take your knees from side to side as far as you can go without pain and provided you feel no more than a mild to moderate stretch. Repeat 10 times provided there is no increase in symptoms
Rotation in Lying ,Hip Flexion
Slowly take your knee towards your chest as far as you can go without pain and provided you feel no more than a mild to moderate stretch (figure 5). Use your hands to gently bring your knee closer to your chest. Repeat 5 – 10 times on each leg provided there is no increase in symptoms.
Knees to Chest
Begin lying on your back with your knees bent. Slowly take both knees towards your chest using your hands to assist as far as you can go without pain and provided you feel no more than a mild to moderate stretch (figure 6). Repeat 5 – 10 times provided there is no increase in symptoms.
Knees to Chest
Begin this exercise on your hands and knees, with your hands in front of you above the level of the head. Gently take your weight back towards your heels, bringing your bottom towards your ankles as far as you can go without pain and provided you feel no more than a mild to moderate stretch (figure 7). Hold for 2 – 5 seconds and repeat 10 times at a mild to moderate stretch provided the exercise is pain-free.
Begin this exercise lying on your back in the position demonstrated (figure 8). Slowly lift your bottom pushing through your feet, until your knees, hips, and shoulders are in a relatively straight line. Tighten your bottom muscles (gluteals) as you do this. Hold for 2 seconds then slowly lower your bottom back down. Repeat 10 – 20 times provided the exercise is pain-free.
Swiss Ball Squats
Begin this exercise in standing with your feet shoulder width apart, your feet facing forwards and a Swiss Ball placed between a wall and your back, as demonstrated. Alternatively, you can perform this exercises with your back against a wall (ideally with a low friction surface). Slowly perform a squat, keeping your back straight. Your knees should be in line with your middle toes and should not move forward past your toes. Perform 10 – 20 repetitions provided the exercise is pain-free. Maintain activation of your transversus abdominis muscle throughout the exercise.
Swiss Ball Squats
Sciatic Nerve Glide
Begin this exercise lying on your back, with your knee supported above your hip (by your hands) and your toes held up towards your shin. Slowly straighten your knee as far as you can go without pain and provided you feel no more than a mild to moderate stretch, then return to the sta
The main goals of chiropractic care in the treatment of spondylolisthesis include:
- Optimize good spinal mechanics
- Improve posture
- Improve spinal function
Chiropractors do not reduce the slippage of spondylolisthesis. Instead, they address the spinal joints above and below the slipped vertebra—helping to address the mechanical and neurological causes of the pain, not the spondylolisthesis. This can help relieve low back pain and improve motion in the region.
Chiropractic Treatments for Spondylolisthesis
Your treatment plan depends on your symptoms. Your chiropractor may use one of the different types of spinal manipulation (also referred to as a “spinal adjustment”)—active, hands-on techniques that help restore spinal motion—to improve joint motion. Spinal manipulation techniques your chiropractor may use include:
- Specific spinal manipulation identifies the joints that are restricted or those that show abnormal motion. A gentle thrusting technique that helps to return motion to the joint by stretching the soft tissues and stimulating the nervous system.
- Flexion-distraction technique is a gentle, non-thrusting type of manipulation usually used for degenerative disc conditions and facet strain that may be related to spondylolisthesis. This treatment is hands-on and uses a specialized table to assist the chiropractor—but instead of direct force, it’s a slow pumping action.
- Instrument-assisted manipulation is another non-thrusting technique. With this technique, the chiropractor applies force using a hand-held instrument without thrusting into the spine.
Your chiropractor may also use manual therapies in addition to spinal manipulation to treat injured soft tissues, such as muscles.
- Trigger point therapy helps the chiropractor identify specific hypertonic (tight), painful points on a muscle. He or she puts pressure (using his or her fingers) on these points to reduce the tension.
- Manual joint stretching and resistance techniques, such as muscle energy therapy, can be used.
- Instrument-assisted soft tissue therapy can help treat injured soft tissue of the spine.
[bg_collapse view=”button-orange” color=”#4a4949″ expand_text=”Show More” collapse_text=”Show Less” ]