Non-surgical Management of Spondylolisthesis in Adults

Abstract

Low-grade spondylolisthesis in adults more commonly has an isthmic or degenerative etiology and slip progression is uncommon, with most patients responding to non-operative treatment.

A non-operative treatment algorithm for patients with spondylolisthesis does not exist currently and the lack of standardized treatment protocols and level-I evidence presents a challenge to the spine surgeon when contemplating which non-operative treatment options are optimal.

Although there are no data supporting one non-operative treatment over another, most authors recommend a patient-centered, multi-discipline approach. The mainstay of prescribed non-operative treatment includes activity modification, physical therapy with core strengthening and flexion exercises, along with NSAID therapy. Bracing should be considered if the patient’s body habitus permits and they are compliant with participating in PT. Although there is no data to support the long-term efficacy of steroid injections, they may offer diagnostic value in the surgical plan.

The patient’s symptomatology should provide the tactical approach to treatment in the short-term, and clear long-term goals should be developed with the patient at the onset of treatment so patient expectations are realistic and achievable. Those patients who fail an initial 6-month trial of conservative care are less likely to improve and surgical management may result in improved outcomes when compared with continued non-operative management.

The surgeon must invariably work with each patient as the head of a multi-disciplinary team for non-operative management to be effective while maintaining clear objectives to define both success and failure of such management.