The goal of treating spondylolisthesis is to stabilize the spinal segment and stop or reverse the progression of the slippage. This video describes the spectrum of treatment options for spondylolisthesis, from pain medications to physical therapy.
Video presented by Zinovy Meyler, DO
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This video also accompanies the article: Spondylolisthesis Treatment.
Typical treatments for spondylolisthesis; some are for the usual back complaints and back muscle spasms, but it really is guided by the degree of the slippage. First of all, of course, we have to evaluate for instability. If there is instability, then that has to be restabilized and there are different ways of doing that. Initially and immediately, we can use bracing in order to stabilize the spine and also prevent any further damage to the structures that are usually protected by the vertebrae themselves. Those are nerves and vessels that are essential to the functioning of our body, of our limbs, depending on where the slippage occurs. That is stabilizing and sometimes if there is a truly unstable segment, then surgical intervention is necessary in order to prevent anything else from progressing. In other words, from nerves being pinched, from this slippage to progress and then become a medical emergency, sometimes it is done preemptively.
Otherwise, the muscle spasms that usually follow the muscular tension balancing is an important aspect in treating spondylolisthesis. Strengthening of the core muscles and intrinsic muscles of the spine are also very important because now there is more of a need for that support because some instability in the spine - and I use that term inappropriately, if you will, right now because instability and stability are very specific terms if we are to consider surgery or any other interventions - but we do have to consider the fact that, in order to prevent this from progressing, we need to create more stability. That stability is usually created by addressing the postural changes, addressing the core muscles that will stabilize and create a "muscular corset," if you will, that will not only support but will also physiologically support the spine as we move and as we do different activities.
Other things to consider, especially in the initial injury, is activity modification. So what we need to do is we need to prevent stresses to the spine and this is very important in adolescents and young adults that are active in different sports and sometimes this is due to that sport or an injury during that sport. They must modify their activity because they need to prevent further injury.
Also what's important is controlling the pain. Controlling the pain can be done through use of oral medications, but also that lysis or that fracture site can be painful in itself. In order to control pain that comes from the site of the fracture or that lysis itself, what we can do is, under controlled conditions, we can put medication directly at that site. The way we do that is by using x-ray or fluoroscopy guidance to know that we're exactly at that spot and that can provide immediate relief and by using corticosteroid in conjunction with that anesthetic, it can actually provide reduction in inflammation, which usually accompanies the injury and drives some of the pain as well.
So, overall, we have to establish the fact that it's stable before we actually begin the treatment because our treatment will really depend on stability of the segment.