Patients come to the Spine Institute Northwest to see Dr. Solomon Kamson every day complaining of lower back pain, and it is up to him to accurately diagnose and treat the problem. One cause of lower back pain is spondylolisthesis, a condition where one of the vertebrae slips onto the vertebrae below it. The slipped bone will often press on a nerve, causing severe pain the back and hamstrings. There are five major types of spondylolisthesis: dysplastic, isthmic, degenerative, traumatic, and pathologic. Once it is diagnosed, spondylolisthesis surgery can be performed to correct the problem and ease the persistent pain.
The symptoms of spondylolisthesis cannot be seen on the outside of the body, so the physician must do a thorough physical examination to see if the symptoms match the condition. He then orders tests like an x-ray, MRI, and a CT scan to get a view from the inside. The x-ray will show if the bone is out of place. The MRI or CT scans are needed to show which bones and nerves are affected.
After the doctor diagnoses the problem, a treatment plan is developed. In less severe cases, rest, NSAIDs, prescription pain medication, steroid injections, and physical therapy are the initial course of treatment. A back brace is another option to help stabilize the spine. If these treatments fail or the case is extremely severe, then the surgeon might recommend surgery to ease the pain.
The main goals of performing surgery for this condition are to ease the pain from the compressed nerve, stabilize the spine, and restore the patient’s ability to function normally. There are two types of surgery performed to help correct the symptoms of spondylolisthesis, and the surgery performed depends on which of the five types of the problem the patient suffers from.
A decompressive laminectomy is a procedure that involves removing part of the bone that is compressing the nerve. The surgeon will open up the spinal canal, giving the nerves more room to breathe. This is often followed by a spinal fusion to stabilize the area where part of the bone was removed.
When the patient has isthmic spondylolisthesis, a spinal fusion is performed. Surgery is only considered when the patient has tried other methods of non-surgical treatment with no success for at least six months. Surgeons use an anterior approach, going in through the abdomen to get the best access to the disc space. Part of the bone is removed and replaced with a bone graft. The bones are then fused together using metal rods, screws, and hooks.
The outlook for patients who have spondylolisthesis surgery is good because the laminectomy and fusion relieve the pressure on the nerve roots, easing the back pain. When nonsurgical treatments fail, patients still have hope for a pain-free life from surgery. The first step is to see a spine specialist and get the problem accurately diagnosed.