What is Spondylolisthesis and When is Surgery Needed?

Spondylolisthesis is a spinal condition where one of the vertebrae displaces or slides forward over the bone beneath it. This condition can emerge in various parts of the spine, but it’s predominantly found in the lumbar spine (lower back). On occasion, it also appears in the cervical spine (neck).

A major concern with spondylolisthesis is that the slipping bone can exert pressure on the spinal cord or adjacent nerves. This pressure can manifest as pain, muscle weakness, sciatica, spinal stenosis, or even damage to the spinal cord itself. Over time, it can cause debilitating symptoms which could significantly hamper one’s quality of life.

The decision for surgical intervention usually stems from the degree of discomfort experienced by the patient, as well as potential risks posed to nerves and surrounding spinal structures. Typically, surgical recommendations arise when:

There is a severe or high-grade slippage of the vertebra, such as cases where over 50% of the vertebra slips forward.
The slippage is likely to damage nerves or the surrounding spinal structure.
The patient suffers from intense pain or muscle weakness in one or both legs.
There is progression of back and/or leg pain that is intolerable and doesn’t improve with conservative treatments.
Patients display symptoms of numbness and/or weakness.

Before resorting to surgery, physicians often suggest nonoperative measures such as physical therapy, medication, and activity modulation. Fortunately, symptoms of spondylolysis (a precursor to spondylolisthesis) typically respond positively to these treatments. However, if pain persists despite these interventions, surgical options are considered.

The primary surgery recommended for adults with spondylolisthesis is spinal fusion. The procedure aims to stabilize the “slipping” spine levels by placing bone grafts along with metal rods and screws. In certain cases, surgeons might also recommend a laminectomy to decompress the nerves.

For more detailed information on spondylolisthesis and its treatments, you can refer to resources from leading institutions such as HSS, Wexner Medical Center, and University of Virginia School of Medicine among others.