Treatment Options for Spondylolisthesis

Prognosis for Spondylolisthesis

If spondylolysis is discovered because of back pain and responds to therapy, there are usually no restrictions on physical activity. The chance of developing spondylolisthesis is small. Many physicians recommend that exercises for stretching and strengthening back muscles be continued even after pain resolves.

The overall prognosis for people with spondylolisthesis is good. In the majority of people, slippage does not progress and even if it does, it usually does not exceed Grade I or II. Eighty percent of people (children and adults) with up to Grade II spondylolisthesis respond well to conservative therapy and are symptom free. For those patients who do not respond to conservative measures and require surgical intervention, the rate of success is approximately 95%. For the minority of patients whose spondylolisthesis is Grade III or IV, surgical intervention is almost always necessary to prevent further slippage or to treat symptoms. Fortunately, there are surgical procedures, namely fusion with stabilization (instrumentation), laminectomy, and decompression that have high success rates.

If spondylolisthesis is present in youth, close follow-up is necessary, especially for young girls. If, during the years of skeletal growth, the slippage is higher than Grade II, there is a greater potential for additional slippage as the child grows. The risk of slippage is highest until the ages of 14-15. Non-strenuous sports may be acceptable but participation in any sports activities should be discussed with a health care provider before commencing. Low grade isthmic spondylolisthesis can progress in an adult but is often related to progressive degeneration of the L5-S1 vertebral disks.

Patients at higher risk for slip progression include:

• Patients with dysplastic vertebrae
• Patients with higher slip angles

Higher grades of spondylolisthesis have a more variable prognosis especially if radicular pain is present or if there is disk degeneration. Degeneration usually happens faster at the level of the spondylolisthesis than in other parts of the spine. Surgical procedures have a high rate of success.

Degenerative spondylolisthesis can be very painful since in addition to degenerating bone, there also may be degenerating disks, compression and stenosis. Conservative therapy is effective for many people and surgical options are available if necessary. Response to surgery is good. Spondylolisthesis is not associated with increased mortality.