Spondylolisthesis Diagnosis & Treatments
How is Spondylolisthesis Diagnosed?
A spine-trained physician typically diagnoses Spondylolisthesis. Accurate and thorough diagnosis is key to selecting the best treatment options. The following is part of a comprehensive diagnostic workup:
- Medical history – Assessment of symptoms, previous treatments and care.
- Physical examination – A careful examination by a spine specialist for limitations of movement, problems with balance, and pain. The examination should also cover loss of reflexes in your extremities, muscle weakness, loss of sensation or signs of spinal cord damage.
- Diagnostic tests – Generally, plain x-ray films are taken which allows the physician to rule out other problems such as infections. CT scans and MRIs are often used to give them a three-dimensional view of the lumbar spine and can help detect herniated discs.
- X-rays of your back can show slippage and or fractures of the vertebrae. Also, a MRI and CT scan can pinpoint the damage and help determine the degree of spondylolisthesis and better guide the treatment plan.
What are the Treatment Options for Spondylolisthesis?
Most treatment plans start with discontinuing any physical activity that may have caused the condition to happen. Anti-inflammatory medicines such as ibuprofen (Advil) or naproxen (Aleve) are prescribed in order to reduce the inflammation and pain. Physical therapy is also very important to strengthen the core abdominal and low back muscles to provide stability and reduce further damage. When obesity or being overweight is the cause of the spondylolisthesis, weight loss may be very helpful.
- Medications: anti-inflammatories, muscle relaxers and on rare occasions narcotic medications
- Alternating heat/cold therapy during the first 24-48 hours
- Physical therapy Exercises: including stretching, massage, and strengthening
- Epidural steroid injections are used two-fold, first, to relieve inflammation of the affected spinal nerve and secondly, diagnostically to confirm the correct affected level at which the pain originates from.
Least Invasive Procedures
If after 6 months of conservative care and the pain becomes unbearable, and the degree of slippage continues, or if there is compression on the spinal nerves related to the spondylolisthesis, a minimally invasive procedure such as endoscopic foraminalplasty can be helpful.
- Endoscopic Foraminalplasty: In some grade I or II Spondylolisthesis patients, endoscopic foraminalplasty works well. The goal of the surgery is to decompress the foramen (bones around the compressed nerve) and exiting nerve in order to relieve the pressure without destabilizing the facet and thus avoiding a spinal fusion. Unlike traditional spinal fusion surgery, a less than 1/2 inch incision is made in the skin. Your muscles are spared and only dilated in order to gain access to the surgical site. The physician uses a working channel endoscope that allows for water and instruments to pass through the scope with an HD camera attached that provides a superior view of the anatomy and the spinal cord. The patient is under conscious sedation alert and confortable throughout the procedure. No general anesthesia is needed and thus lower risk to the patient.
Minimally Invasive Spine Surgery
- MIS Microdiscectomy – Usually an open procedure or using tubular retractor with an incision of 1 inch. The surgeon usually observes through a microscope or set of eyeglass loupes that help magnify the anatomy. Most of the pain, post-operative, is from the approach the surgeon made through muscle in your back. Anesthesia is necessary.
- MIS TLIF – The surgery involves removing the damaged intervertebral disc and replacing it with a piece of bone or PEEK cage packed with bone, to assist in union or fusion of the two vertebral bodies over time. Screws are used to hold the disc still until it fuses.
How Long Is The Recovery?
Our Least Invasive Procedure patients’ can begin getting out of bed one hour after surgery and go home shortly afterwards. There will probably be some pain after the procedure and is usually localized to the incision site. Activity is gradually increased and patients are typically able to return to work around a week to two weeks. Keep in mind just because there is less or no pain, always consult your physician before beginning any physical work.
Our Minimally Invasive Spine Surgery patients’ post-operative recovery is much longer and may involve overnight stay in the hospital. Once your pain in under control you can go home. Dr. Rodriguez will give you medication to control your pain while you recover at home.
At home, you will need to continue to rest. You will be instructed on how to gradually increase your activity. You may still need to take the pain medications for a while. However, pain and discomfort should begin to reduce within a couple of weeks after surgery. The doctor will discuss with you other techniques for reducing pain and increasing flexibility before you leave for home. The doctor will also discuss with you a time frame for when you can resume basic activities such as walking, driving and light lifting, and when you can return to more advanced activities such as physical labor, sports and yard work.