Treatment Options for Spondylolisthesis

Conservative Treatments for Spondylolisthesis

Conservative therapy for spondylolisthesis includes:

• Lifestyle modification
• Physical Therapy
• Drug therapy

Lifestyle Modification

It is important for the patient with spondylolisthesis to become educated about their condition and to take steps to minimize their symptoms and protect themselves from further slip progression. These steps include:

• Reducing or eliminating activities that cause pain
• Bed rest during acute episodes of pain
• Taking analgesics for acute episodes of pain
• Maintaining proper weight (losing weight if necessary)
• Stopping smoking since smoking impacts the healing properties of bones

Physical Therapy

The goals of physical therapy include:

• Restore range of motion
• Restore maximum function
• Strengthen and stabilize the spine

Physical therapy regimen may include:

Passive Physical Therapy

Passive physical therapy techniques that may be used to relieve pain include:

• _ Phonophoresis_ - the use of ultrasound therapy to deliver topically applied analgesics deep into muscles or joints
• Electrical stimulation
• Hot/cold packs
• Massage therapy
• Traction
• Transcutaneous electrical nerve stimulation (TENS)

Active Physical Therapy

Active physical therapy exercises that may be used include:

• Spinal flexibility exercises
• Stretching and strengthening of abdominal and lumbar muscles
• Pelvic stabilization exercises
• Exercises to improve posture
• Isometric exercises - pushing the pelvis against an immovable object, such as the floor
• Isokinetic exercises - lifting, pulling, or pushing at a constant speed
• Aerobic exercises - increasing heart rate and blood flow to muscles, such as running and swimming

Active physical therapy usually is initiated when acute pain resolves. Gentle exercise may be introduced before complete resolution of pain and as the pain is reduced, the intensity of exercise may be increased.

Physical therapists are also involved in teaching the individual how to modify aspects of their daily routine in order to protect themselves against further injury (e.g., how to lift properly, movements to avoid, how to maintain proper posture).

Corset/Brace

A brace (also called orthosis) provides additional support to the spine and in some cases also decreases pain and muscle spasms. Corsets are not as rigid as orthoses and are typically made of a strong fabric that provides support.

For patients whose slip is less severe, ready-made braces which are made of hard plastic may be sufficient. However, in some circumstances, particularly if there is a significant degree of slip, the physician may prescribe a custom-made brace which is specially fit by an orthotist. The orthotist will teach the patient how to put on and take off the brace as well as give helpful hints about ways to stay comfortable while wearing the brace. It is important to comply with the orders regarding the number hours per day that the brace is to be worn and the duration of time (weeks/months) even though it may be uncomfortable.

Drug Therapy

Medications that may be used to relieve pain from spondylolisthesis include:

• Non-steroidal anti-inflammatory drugs (NSAIDs) - examples include acetaminophen (Tylenol), ibuprofen (Advil, Motrin), and naproxen (Aleve, Naprosyn). These medications should be used judiciously since there is evidence that NSAIDs may inhibit bone healing. Long-term use of NSAIDs may also cause other problems such as gastrointestinal bleeding.
• Narcotics (e.g., codeine) may be used only for acute exacerbations of pain for a brief time period of time
• Muscle relaxants
• Cortisone to reduce inflammation - this may be given orally or by injection for a short period time since it is associated with several side effects (e.g., risk of infection and weight gain).
• Epidural injections, spinal blocks, or nerve root blocks - this type of treatment involves injection of steroids or local anesthetics into the epidural space (area around the spinal cord) or the facet joint (area between the vertebrae). Usually one injection is administered and is followed by another one or two additional injections at a later date as needed. This is considered a second-line treatment to be used only if symptoms plateau and are no longer responsive to other interventions.

Use of narcotics and muscle relaxants for pain relief is controversial and, if they are prescribed, it is only for a short time to treat initial pain following the injury.