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If a patient who has isthmic spondylolisthesis is being limited in
activity to an unacceptable point, some form of treatment may be
reasonable. Usually a non-surgical course of treatment will be recommended,
and only if that is unsuccessful will the more aggressive surgical
treatment be considered.
Conservative (non-surgical) treatments
Conservative treatment methods are designed to reduce the level of pain
being experienced. Although it may not make the patient pain free, if it
helps manage the pain and allows the patient to be more functional it
should be considered successful. Attempts at controlling the pain may include
the following:
·
Rest. This would probably be limited
to no more than a few days, to see if it helped alleviate the symptoms.
·
Anti-inflammatory medications.
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (e.g.
Advil, Motrin, or Nuprin) and naproxen (e.g. Aleve or Naprosyn) can be used
to reduce swelling and inflammation that may be causing pain in the
affected area. Stronger therapies, such as oral steroids or epidurals, may
be prescribed to treat severe flare-ups if needed.
·
Pain reducing medications.
Acetaminophen (e.g. Tylenol) can be used to reduce the pain. Because it
acts in a different way than the anti-inflammatory drugs, the two types may
be used together, and are often very effective when used that way. If the
pain is severe, the doctor might prescribe a stronger medication such as
codeine for short-term use.
·
Physical therapy and exercise. With
proper exercise and therapy the muscles around the affected area can be
strengthened, which can reduce the amount of movement which causes pain.
·
Injections. Depending on which
structures is thought to be producing the pain, a pars interacticularis,
selective nerve root, or epidural injection may considered to reduce the
pain and allow the patient to progress further with their rehabilitation.
Surgical treatment
In some cases, conservative treatments are not enough to relieve the pain
to a degree where the patient can maintain an acceptable level of activity.
In those instances a surgical remedy might need to be considered.
The pain in isthmic spondylolisthesis is caused from the vertebrae
sliding forward and a nerve being compressed. To successfully relieve this
pain, the surgery needs to remove the pressure on the nerve and then
fusing. If the motion is eliminated in a painful motion segment the pain
should subside.
Spinal fusion involves using a bone graft and attaching it to the spine,
often using instrumentation such an anterior cage and/or screws or rods.
The bone graft can be taken from the patient’s hip (autograft bone)
during the fusion surgery, or taken from cadaver bone (allograft bone).
Bone graft substitutes may also be used. Over the course of about three
months the bone will grow together and functionally spot weld the two
vertebral bodies together. During that period of time the patient’s
activity level should be limited to allow the bone to grow. Once it has
grown together, activity will actually help the bone remodel. Bone is a
live tissue, and when stressed it will become stronger.
The L5-S1 level does not move that much, so fusing it together does not
change the biomechanics in the back all that much. Generally, after the
fusion has taken, no activity restrictions are necessary, and the patient
may do their activities as tolerated. They should also not notice any
decrease in the range of motion of their back.
It should be noted that with any spine fusion surgery, one of the risks
of the procedure is that despite a successful fusion the patient’s
pain does not go away. However, a fusion procedure for an Isthmic Spondylolisthesis
tends to be a very reliable procedure, and 90-95% of patients will be able
to function better with less pain after they have healed.
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