Back Pain

Back Surgery Best for Patients with Degenerative Spondylolisthesis

The recently released results of the second SPORT study showed that patients who selected surgery to treat their lumbar degenerative spondylolisthesis had better outcomes when compared with those who selected nonsurgical treatment. The study included two groups of patients:

Randomized group – 304 patients
In the randomized group, 304 patients were randomly selected to receive either standard posterior decompressive laminectomy (with or without a spinal fusion) or nonsurgical care. Nonsurgical treatments included physical therapy, epidural steroid injections, NSAIDS, and opioids. There was significant crossover from patients in the surgical and nonsurgical groups, with 64% of the surgical group having surgery and 49% of patients assigned to nonsurgical care also having surgery.

Because of the large percentage of patients who crossed over to from non-surgical treatment to surgical and vice-versa, the results of the study are really only meaningful by evaluating how the patients were actually treated, (vs. by their randomized groups).

Observational group – 303 patients
This group was allowed to choose whether to have surgery or receive nonsurgical treatment. 97% of patients who selected surgery went through with the operation, and 25% of the nonsurgical group ultimately chose surgical treatment.

The study showed that patients in both groups who chose surgery to treat their lumbar degenerative spondylolisthesis and spinal stenosis fared significantly better in terms of pain relief and function at 3 months, 1 year, and 2 years than those who received non-surgical treatment.

The surgery for spondylolisthesis included a decompressive laminectomy with or without an accompanying spinal fusion.

The large cross-over of patients and the favorable outcomes show what doctors and patients already know: those with pain fare best when their care was left to the individual discretion of patient and surgeon.

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Subject: Degenerative

Degenerative Spondylolisthesis can be very unstable and are hard to treat. Spondy's are graded according to how far the vertebrae above has slipped anterior to the vertebrae below. They are Graded I-IV. They are also categorized as stable or unstable according to how much they slip anterior and posterior during flexion and extension. This slippage coupled with the abnormal weight distribution can cause the disc and vertebrae to degenerate abnormally. Some patients get severe spinal cord and nerve compromise. Surgery is definitely a smart choice in many cases and these outcomes do not suprise me. However, I would be curious exactly what the nonsurgical treatment methods were.
Dr Eben Davis
June 6th, 2007

Subject: Thank you for your

Thank you for your comments.?r?nOne of the drawbacks of the study, as outlined by the authors, is that the non-surgical treatments were not consistent among the patients in the non-surgical group. The non-surgical treatments used in the study consisted of any combination of physical therapy, epidural steroid injections, NSAIDS, and opioids.?r?nStephanie
spine-health
June 6th, 2007

Subject: I, too, had

I, too, had spondylolisthesis at L-4, L-5 and had these two vertebrae fused on June 18, 2004. Along with this procedure, a laminectomy was performed. Greatest decision I ever made. I was to the point that I could not stand or sit for any length of time, not even to shop for a little while. I am a teacher and I was pretty miserable during the last 9 weeks of school prior to surgery. I returned to school fulltime at 10 weeks postop still not feeling capable of driving myself to and from work. Still don't do everything I used to as I markedly guard my back but the pain just is not there. I followed my surgeons's directions very closely. I take nothing for pain and have not on a regular basis for at least 2 years. Sorry that others have not had the good result that I did.
Patricia Ferguson
June 8th, 2007

Subject: Your surgery

I am on the verge of having a spine fusion on L4-L5,S1 for my spondylolisthesis. My doctor wants to remove the disc and replace it with a plastic one that will have a hole in the center so that the bone can grow into it. He will stabilize the two vertebrae with 2 screws. He says he will only have to make two incisions side by side on my back. Can you tell me if your surgery was similar? Everything I have been reading about fusion is not positive.
Thanks

Jane
April 14th, 2008

Subject: After being diagnosed with

After being diagnosed with denenerative Spondylolisthesis I opted for surgery. I was 54 at the time. After the first operation I had pain that was exponetially greater than what I started with. I had a four more surgeries trying to find the problem. I'm fuzed from L2 to S1 with more pain than I know what to do with. Bad decision to opt for surgery. I believed in my surgeon and stayed with him for all five surgeries.?r?nSigned?r?nJohn (Monday morning quarterback)
John Furnell
June 8th, 2007

Subject: I am suffering from disc

I am suffering from disc prolapse (L5-S1)since 2000 and now I am 51 yrs old.I am not taking any medicine and not able to do exercise also daily.I wonder whether to go in for surgery or not,by the above experiences shared by our friends.
kannappan.sv
June 9th, 2007

Subject: Patricia Ferguson-?r?nWhat

Patricia Ferguson-?r?nWhat 'device'was used to fuse your discs??r?nThanks if you can answer this. Mom is considering surgery on L4-L5.-glad to hear you are doing well.
Angie
June 11th, 2007

Subject: I had my first fusion in

I had my first fusion in 2001 (L4/5 fused with screws, rods). In 2006 I had to have a 2d fusion as the Sl let go. The second surgeon removed ALL the other metal and re-fused L2/3,L4/5/&Sl, plus did a discectomy. Now, I have "neuropathy" in both feet....Excruiating pain all the time and I cann't walk any distance, stand long or sit long...I don't know what happened but the Surgeon recommended this 2d fusion. Additionally, my cervical spine is gone from C4/5/6. I try to deal with ALL this pain without taking meds as my stomach is too sensitive. I have decided to try "nerve blocks" and the Pain Mgmt Dr., states if these don't work---then I'm destined to a "morphine pump"...God help me!!! I have become suicidal; have no quality of life left....Any suggestions? Have "nerve blocks" worked for anyone? Would you agree to a "morphine pump? Any info would be appreciated....Thank you and God Bless you...
Joyce Angell
June 24th, 2007

Subject: fusion surgery

I had fusion surgery in 2003 with the screws and bolts and did very well for about 3 yrs. except the pain never completley went away. The back spasms stopped and I led a pretty active life. What my surgeon failed to tell me before surgery was that I would probably need another fusion above the first fusion at some point in my life. I found this out AFTER he did the fusion. Now, with extensive pain, he says I need the other fusion. I am scared that with passing years, he will be fusining other veterbraes until my whole spine is fused so now I am just putting up with the pain which he acts like he can't understand. I have taken all kinds of injections, but none help my back. Every doctor acts like I am making all the pain up. I don't understand their indifference to the pain I am constantly in. Just know that if you dr. does not tell you, and you have a fusion, you may need another in a few years because the part that is fused does not move, leaving the vertebraes above to do all the work until they are worn out also.

Mandy
February 25th, 2008

Subject: interesting....

I came across your comment & almost closed the window before I realized that you just posted this last week. I am thinking about having back surgery. I have bone-on-bone at the L5S1 disc level & 50% listhesis (top sliding off bottom bone), it's 2nd degree spondylolisthesis. I've been doing all the alternatives with teh med's & injections which aren't helping anymore. I'm only 39 years old & a single mother of 3 very active daughters. My Dr. just showed me my latest MRI that has a clear view of all the disks above the damaged one & they look great.. I am worried that in the future I will have to have them all fused. Where did you have yours fused, at what levels?

Michelle
March 3rd, 2008

Subject: l4-l5 nothing that I can operate on

I have had constant pain since I tore the L4-L5 dis ten years ago. I have seen two neurosurgeons and both said they saw nothing they could operate on. I take over the counter pain medication and have had steroid shots which only stopped the pain for a couple weeks. I like to ski and jog and am 50. Are there any new treatment for a problem nobody seems to be able to diagnose?

David B
June 13th, 2008

Subject: fusion surgery

Like other's here I had a previous spinal fusion at L5/S1 with pedicle screws and plate in Nov. 2005(done at a community hospital). I had nerve roots decompressed with 3 months, of marked improvement. My pain now is far worse then prior to my surgery, with back, leg and bilateral foot spasms. I am unable to stand or walk for more then a few mins, and I tolerate sitting somewhat better.
I went to Hospital for Special Surgery In NYC and found out my 1st surgery never healed, my grade 2 spondylolisthesis was never reduced or put back in alignment, and my screws were also not in correctly. The doctor told me that he could have moved my spine into place and fixed it right the 1st time. Now I have to wait for the results of further testing to see if he can do a 2nd corrective fusion surgery for me. Please, for those of you yet to have surgery, make sure you go to a spinal surgeon that is well versed in spondylolisthesis and that the hospital is a state of the Art Medical Center. Staying with a doctor in my area has changed the quality of my life, for the worse, forever. Also, never go to the same doctor for repeat surgery, unless they are the best of the best.

jerrysmom
June 20th, 2008