A good doctor will not commence spondylolisthesis treatment without first being completely sure that the severity of the vertebral misalignment warrants therapy at all. In order to judge whether or not treatment may be needed, the extent of slippage must be studied and evaluated to determine if any pain-inducing mechanisms are demonstrated in the particular patient.
The diagnosis of spondylolisthesis can only be made using some sort of skeletal imaging study. X-rays are the most common form and will show the extent of vertebral slippage. If symptoms are present, the doctor will usually order a spinal MRI or CT scan to accurately visualize both the affected bone and its potential effects on the surrounding neurological tissues. The MRI scan should be able to see exactly what potential effects the slipped vertebrae is having on the spinal canal, the neuroforaminal spaces and the rest of the spinal anatomy.
This report covers the most common and effective treatment options for various forms of spondylolisthesis.
If minor or no symptoms are present, there really is no need for any treatment. Spondylolisthesis is not usually a painful or harmful condition in its more conservative forms. Patients who are experiencing pain will often be interviewed about the circumstances during which pain occurs. Patients are usually advised to avoid high risk activities which may jar their spines, causing pain.
If there is significant pain or worsening pain, treatment will typically be provided. Spondylolisthesis therapy can take several forms, ranging from conservative to drastically invasive. It is the decision of the care provider which therapy method will be best for the patient. In order to ascertain this ideal treatment method, the diagnostic evaluation must be thorough and accurate or else results are almost sure to be poor.
Conservative treatment will build up the surrounding muscles and seek to provide a more comfortable range of motion. The most common form of active treatment is physical therapy. The patient is given a number of specific back exercises that will work to relieve pain and reduce further slippage. Activity-related exercise may be the most effective and might include such fitness regimens as Pilates and yoga.
Less constructive treatment usually involves the use of back braces and orthotics. While these medical tools are helpful in some instances, they can also weaken the muscles and further reduce the comfortable range of motion. Orthotic braces should usually only be prescribed for spondylolisthesis conditions where the degree of vertebral slippage has actually compromised the integrity of the spine.
In the complementary sector, chiropractic adjustments are often used to treat vertebral misalignment. Massage, TENS and acupuncture might be used as symptomatic modalities, although none of the above are likely to provide any semblance of a cure.
Surgical correction of vertebral misalignment is sometimes used as a last resort therapy. If vertebral slippage continues and the symptoms get worse, surgery is considered a drastic, but potentially effective solution.
A spinal fusion will be performed, securing the vertebrae back into its proper place. If there is any suspicion of a relapse of spondylolisthesis, internal hardware, including pins, screws and/or cages, might be used to fix the slipped vertebra back in place permanently.
Radicular impingement enacting a pinched nerve might be the cause of pain for some patients. In this case, a laminectomy will often be performed, as well.
Remember, spondylolisthesis treatment is only necessary in a small percentage of people who have symptomatic versions of the condition. The remainder should merely have their spines monitored regularly, to ensure that no problematic degeneration of the misalignment occurs.