Spondylolysis and Spondylolisthesis part 2.

Spondylolysis and Spondylolisthesis part 2.


The goals of treatment for spondylolysis and spondylolisthesis are to:

  • Reduce pain
  • Allow a recent pars fracture to heal
  • Return the patient to sports and other daily activities

Nonsurgical Treatment

Initial treatment is almost always nonsurgical in nature. Most patients with spondylolysis and low-grade spondylolisthesis will improve with nonsurgical treatment.

Nonsurgical treatment may include:

Rest. Avoiding sports and other activities that place excessive stress on the lower back for a period of time can often help improve back pain and other symptoms.

Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs such as ibuprofen and naproxen can help reduce swelling and relieve back pain.

Physical therapy. Specific exercises can help improve flexibility, stretch tight hamstring muscles, and strengthen muscles in the back and abdomen.

Bracing. Some patients may need to wear a back brace for a period of time to limit movement in the spine and provide an opportunity for a recent pars fracture to heal.

Over the course of treatment, your doctor will take periodic x-rays to determine whether the vertebra is changing position.

Surgical Treatment

Surgery may be recommended for spondylolisthesis patients who have:

  • Severe or high-grade slippage
  • Slippage that is progressively worsening
  • Back pain that has not improved after a period of nonsurgical treatment

Spinal fusion between the fifth lumbar vertebra and the sacrum is the surgical procedure most often used to treat patients with spondylolisthesis.

The goals of spinal fusion are to:

  • Prevent further progression of the slip
  • Stabilize the spine
  • Alleviate significant back pain

Surgical Procedure

Spinal fusion is essentially a “welding” process. The basic idea is to fuse together the affected vertebrae so that they heal into a single, solid bone. Fusion eliminates motion between the damaged vertebrae and takes away some spinal flexibility. The theory is that, if the painful spine segment does not move, it should not hurt.

During the procedure, the doctor will first realign the vertebrae in the lumbar spine. Small pieces of bone—called bone graft—are then placed into the spaces between the vertebrae to be fused. Over time, the bones grow together—similar to how a broken bone heals.

Prior to placing the bone graft, your doctor may use metal screws and rods to further stabilize the spine and improve the chances of successful fusion.

In some cases, patients with high-grade slippage will also have compression of the spinal nerve roots. If this is the case, your doctor may first perform a procedure to open up the spinal canal and relieve pressure on the nerves before performing the spinal fusion.

Spondylolisthesis treated with spinal fusion
(Left) Preoperative x-ray of a 12-year-old spondylolisthesis patient with a painful high-grade slip (arrow). (Right) After spinal fusion and stabilization with rods and screws, the patient’s pain has improved. Reproduced from Sponsellar PD, Akbamia BA, Lenke LF, Wollowick AL: Pediatric spinal deformity: what every orthopaedic surgeon needs to know. Instru Course Lec, Vol. 61. Rosemont IL. American Academy of Orthopaedic Surgeons, 2012, pp. 481-497.


The majority of patients with spondylolysis and spondylolisthesis are free from pain and other symptoms after treatment. In most cases, sports and other activities can be resumed gradually with few complications or recurrences.

To help prevent future injury, your doctor may recommend that your child do specific exercises to stretch and strengthen the back and abdominal muscles. In addition, regular check-ups are needed to ensure that problems do not develop.

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