Clinical studies have found varying degrees of healing using conservative (non-surgical) treatments (such as bracing) ranging from 73% healing of early-stage spondylolisthesis versus 38% healing in those with progressive disease. One study of adolescent athletes found that 37% of them showed signs of healing at the pars defects after 2 to 6 months of bracing.1
Treatments for Active Spondylolysis
The recommended treatment program for active spondylolysis is usually a combination of the following:
- Bracing to immobilize the spine for a short period (e.g. four months) to allow the pars defect to heal
- Pain medications and/or anti-inflammatory medication, as needed
- Stretching, beginning with gentle hamstring stretching and progressing with additional stretches over time
- Exercise that is controlled and builds gradually over time.
On rare occasions, spondylolysis that is not healing or may have neurological components can require surgery to provide internal fixation and stability to the area. Usually, two procedures are performed as part of the same surgery:
- A decompressive laminectomy, which reduces irritation and inflammation in the area (but increases spinal instability)
- A spinal fusion to provide stabilization of the affected area.
Treatments for Inactive Spondylolysis
For inactive spondylolysis, bracing is usually not necessary. In many cases, however, the spondylolysis will be discovered long after the pars defect has already healed. This condition is often referred to as chronic inactive spondylolysis and may produce symptoms of chronic or recurring lower back pain or discomfort.
Medical literature indicates that once the lesion has healed and becomes inactive, the likelihood of significant progression is minimal, and only rarely does the slippage require surgical intervention.
For discomfort or pain associated with chronic inactive spondylolysis, there are several treatment options available, including pain medications, chiropractic or osteopathic manipulation, physical therapy and exercise.
For patients seeking chiropractic or osteopathic manipulation for this condition, it is important to note that there is no evidence in the medical literature that manipulation can reduce slippage or cause an active site to heal. But there are some case studies to show that manipulation will often provide temporary pain relief for the patient. This is because appropriate manipulation treatment can relieve many of the side effects of spondylolysis, such as lower back pain caused by stresses on various spinal structures, including the facet joints.
In general, most people with chronic inactive spondylolysis can find sufficient pain relief through a combination of conservative treatments, such as manual therapy, exercise, and lifestyle changes.
However, it is important to note that any therapeutic approach must take into account that spondylolysis means that there is a potentially unstable area of the spine, so caution and the skill of the treating spine specialist are very important considerations.