Our Summary

The paper discusses a common cause of lower back pain, known as degenerative lumbar spondylolisthesis. This condition occurs when one vertebra (the bones in your back) slips over the one below it, often due to age-related wear and tear.

Understanding the progression of this condition is crucial in deciding what treatment is best for each individual. Initially, non-surgical options such as physical therapy, injections for pain relief, and pain medication can be considered, particularly for less severe cases.

However, if these methods do not provide relief, surgical options are available. These can involve either decompression (relieving pressure on the spinal cord or nerves) alone, or decompression combined with fusion (joining two vertebrae together). This paper is all about the best ways to manage and treat this condition.

FAQs

  1. What is degenerative lumbar spondylolisthesis?
  2. What are the non-surgical treatment options for low-grade spondylolisthesis?
  3. When might surgical intervention be considered for degenerative spondylolisthesis?

Doctor’s Tip

A doctor may advise a patient undergoing lumbar fusion to follow a personalized rehabilitation program after surgery to help improve strength and flexibility in the back and surrounding muscles. This can help prevent future injury and promote overall spinal health. It is also important for patients to maintain a healthy weight, avoid smoking, and practice good posture to support the healing process and reduce the risk of complications. Regular follow-up appointments with the doctor and physical therapy sessions may also be recommended to monitor progress and address any concerns.

Suitable For

Patients with degenerative lumbar spondylolisthesis who have failed conservative therapy and are experiencing symptoms such as severe back pain, leg pain, numbness, weakness, or difficulty walking may be recommended for lumbar fusion surgery. Patients with higher grades of spondylolisthesis, instability, or spinal stenosis may also benefit from lumbar fusion to stabilize the spine and relieve pressure on the nerves. Additionally, patients with recurrent disc herniation or failed back surgery syndrome may also be candidates for lumbar fusion to address ongoing symptoms. Ultimately, the decision to recommend lumbar fusion surgery for a patient with degenerative spondylolisthesis should be made on a case-by-case basis, taking into consideration the patient’s individual symptoms, functional limitations, and overall health status.

Timeline

Before lumbar fusion:

  1. Patient presents with low back pain and possibly radiculopathy or pseudoclaudication.
  2. Patient undergoes conservative therapy such as physical therapy, epidural steroid injections, and pain medications.
  3. If symptoms are not resolved, patient may be recommended for surgical intervention.

After lumbar fusion:

  1. Patient undergoes decompression and fusion surgery.
  2. Patient may experience post-operative pain, swelling, and restrictions in movement.
  3. Patient undergoes physical therapy and rehabilitation to regain strength and mobility.
  4. Patient follows up with surgeon for post-operative care and monitoring of fusion success.
  5. Patient may gradually return to normal activities with improved pain relief and function.

What to Ask Your Doctor

Some questions a patient should ask their doctor about lumbar fusion may include:

  1. What is the success rate of lumbar fusion surgery for degenerative spondylolisthesis?
  2. What are the potential risks and complications associated with lumbar fusion surgery?
  3. What is the expected recovery time after lumbar fusion surgery?
  4. Will I need physical therapy or rehabilitation after the surgery?
  5. How long do the results of lumbar fusion surgery typically last?
  6. Are there any alternative treatments or therapies that I should consider before opting for surgery?
  7. What is the likelihood of needing additional surgeries in the future after lumbar fusion?
  8. How will lumbar fusion surgery affect my daily activities and quality of life?
  9. What can I do to prepare for lumbar fusion surgery and optimize my outcomes?
  10. Are there any specific lifestyle changes or modifications I should make post-surgery to promote healing and prevent complications?

Reference

Authors: Bydon M, Alvi MA, Goyal A. Journal: Neurosurg Clin N Am. 2019 Jul;30(3):299-304. doi: 10.1016/j.nec.2019.02.003. PMID: 31078230