Spondylolisthesis: Treatment, Restrictions, Bracing, Medication
The grade of slip (grades 1-5) and the symptoms will help determine the type of treatment that will be suitable. The doctor will consider the following options:
I. No treatment
Approximately 5% of the population has a spondylolisthesis, most of whom will never need any treatment as their spondylolisthesis is stable, and non-progressive. For adults, treatment is only recommended for those patients who have symptoms of pain and disability. For children, treatment is necessary if they have pain, and when the forward vertebral slip is progressing. Observation is adequate for the adult who has no symptoms or the child who has a minimal spondylolisthesis and no symptoms.
Most patients with spondylolisthesis should avoid activities that might cause more stress to the lumbar spine, such as heavy lifting and sports activities like gymnastics, football, competitive swimming, and diving. Patients, or their parents, must discuss their daily activities and hobbies with their physician to see if they are all right to continue.
II. Bed rest/activity restrictions
Bed rest following an injury to the back is used less and less because of the risk of deconditioning (e.g., loss of muscle tone which delays recovery). Ten years ago, one of your friends may have had a similar back problem and was placed on bed rest for at least ten days. We now know that a shorter period of time, such as two to three days followed by a guided physical therapy program is a better solution to back pain.
Once the spondylolisthesis has been recognized, treatment often consists of a short rest period (two to three days) followed by a physical therapy program by a registered physical therapist who has an understanding of spondylolisthesis.
There should be restriction of heavy lifting, excessive bending, twisting or stooping and avoidance of any work or recreational activities that causes stress to the lumbar spine. Your physician will outline a rehabilitation program to return you to your activities as soon as possible.
It is in your best interest to closely follow the activity program as outlined by your physician, nurse, or therapist to restore your best level of functioning as soon as possible. If your work requires heavy lifting, bending, or stooping, you will not be able to return to that type of work immediately. Specific work restrictions should be discussed with your employer so that a less demanding job may be found for you.
Remember, participating in daily activities are important to both your long-term physical and emotional well-being. While you may not be allowed to participate in some of your favorite sports activities, your physician, nurse, or therapist can help you identify activities that you can participate in, such as swimming, walking in water (i.e., hydro-therapy), and land walking, in addition to your physical therapy program.
Many medications are available to help reduce pain. Your physician may prescribe their use, generally to reduce:
ii. muscle spasms
IV. Corset / Brace
In certain situations a corset or brace is useful to provide additional support to the spine. This support may decrease muscle spasm and pain.
Corsets consist of soft fabric, and may include rigid supports. Corsets can be obtained either through your physician, orthotist (i.e., a person trained to make orthopaedic braces), medical supply company, or pharmacy. Normally a corset is worn when you are up and about, but is often not necessary when you are lying in bed.
Braces are made of plastic and can be ready-made or custom fit. Ready-made braces are appropriate in those patients whose lumbar spine has a near normal contour. If there is a marked forward slip of your vertebra, ready-made braces are often difficult to fit and wear. Some physicians opt for custom-made lumbar braces (orthoses) for all of their patients with spondylolisthesis.
If you require a custom-molded orthoses you will need to see an orthotist. The orthotist will take measurements and apply a cast to make a mold of your body. A custom brace will then be made for you.
When you are first given your brace, you will be advised on:
- how to get in and out of your brace
- increasing the amount of time you spend in your brace each day until your brace schedule is achieved
- watching out for skin irritation (some redness is expected under the brace). If any sores on the skin are noted, remove your brace and contact your physician, nurse, or orthotist immediately for further skin-care instructions.
The brace will be uncomfortable at first. It will take several days for you to begin to like your brace and the support that it gives your spine. Just like getting new dental braces or new shoes, it takes a while to feel comfortable.
Your brace should be worn under your clothing. Wearing your brace over clothing will cause increased pressure where waistbands, buckles, snaps, and buttons can cause skin irritation and sores. You will need to wear a cotton undershirt that is snug fitting under your brace to absorb moisture and prevent skin chaffing. In warm climates you may need to change the T-shirt a couple of times per day to remain comfortable. Underpants and shorts should be worn over the brace to aid in bathroom activities. Bring loose-fitting clothing such as a jogging suit when you go to pick up your brace to be sure that the clothes will go over the brace.
Your physician and nurse will explain how long you will need to wear your brace each day and how long it is expected that you will continue to need your brace. Be sure that you understand your brace schedule and adhere to it as recommended by your health-care team. They will tell you if you are able to remove your brace on special occasions. This will be based on several factors, including your diagnosis, how long you have been under treatment, and physician preference.
Surgery may be recommended for your condition if nonoperative measures (e.g., rest, therapy, bracing), have not improved your condition.
Surgeons may try conservative approaches in some cases, such as bracing, before proceeding to surgery. In the most advanced cases surgeons will probably recommend surgery as the first course of treatment.
This decision to do surgery is based on your symptoms, x-rays, and failure of conservative treatment. It is important that you understand why your physician is recommending a treatment. It is quite common for a spinal patient to seek another opinion regarding treatment. If this will make you feel more comfortable with your treatment program, do not hesitate to ask your physician for the name of another physician who handles similar spinal problems.
The goals of surgery are to remove pressure on spinal nerves (i.e., decompression), and to provide stability to the lumbar spine. In most cases of spondylolisthesis, lumbar decompression would need to be accompanied by uniting one spinal vertebra to the next (i.e. spinal fusion) with spinal instrumentation (i.e., implants that are often used to help aid the healing process). Surgery can be performed from the back of your spine (i.e., posterior) or from the front of the spine (i.e., anterior). Your spinal surgeon will review your particular problem with you and explain what type of surgery you need.
What Can I Expect If I Need Surgery?
I. Preoperative preparation
Prior to your surgery your physician and/or nurse should thoroughly explain to you the planned surgical procedure, the in-hospital routine, postoperative recovery/rehabilitation, and long-term activity restrictions.
Prior to your surgery it is to your benefit to be as active as possible. Pain will often limit the amount and type of exercises that you can do, but simple activities will help you build your stamina and strength prior to surgery. Such preoperative strengthening will help you rehabilitate after surgery. Ask your physician or nurse for directions on preoperative conditioning.
Most surgeries for spondylolisthesis will require blood transfusions during the surgery to replace the blood lost during the surgical procedure. Most doctors will ask patients to donate blood for themselves during the weeks prior to surgery. A blood-donation program will be outlined for you by your physician or nurse.
Immediately prior to your surgery you should meet with your physician or physician's staff once more to go over the surgical procedure, potential complications of the surgical procedure, and sign the surgical consent forms. If you have any questions regarding the planned surgery, be sure to have them answered at this time.
Prior to surgery, complete medical evaluation and appropriate laboratory studies (for example, blood and urine analysis), chest x-rays, and EKGs (i.e., monitoring of your heart) will be obtained. Those specific tests will be based on your hospital's protocols, as well as your health history. If you have any medical conditions, or are taking any medications, bring this to the attention of your surgeon and discuss your surgery with your medical doctor to be sure that you are prepared to proceed with surgery.
If you are a smoker, it would be best that you permanently stop smoking prior to your surgery. You know that smoking is not good for your lungs and heart. There is also scientific data available to show that people who smoke have less of a chance of healing spinal fusions.
As your surgical day draws near, should you develop any cold or flu symptoms, open skin sores/cuts or have any dental problems such as bloody gums or abscesses, you should notify your surgeon or nurse immediately. If there is any concern for an infection elsewhere in your body, elective spinal surgery will be postponed until you are well. This will be disappointing for you and your family but may be necessary for your well-being.
You will be admitted to the hospital on the morning of your surgery. Your Same-Day Admission nurses will work closely with your surgeon to give you the directions you will need for the day of your surgery. Typically, you will not be able to eat or drink after midnight the night before your surgery. Additional instructions may be necessary depending on your procedure, so listen carefully to your pre-operative instructions and follow them closely.