Definition and cause
Spondylolisthesis is a progressive slipping of a vertebra on the one below it. It can follow a bone break of one of the joints that bind the vertebrae to each other (isthmic lysis), and in this case cause symptoms in young adults (aged 15-45 years), or it can be the result of a form of osteoarthritis that will deform the joints between the vertebrae and at the same time lead to a lumbar spinal stenosis, usually after 60 years of age. The latter case is dealt with in the lumbar spinal stenosis section.
Course of the disease
The fracture or isthmic lysis that is the cause of the spondylolisthesis often occurs in childhood and goes unnoticed most of the time. The person can live with this fracture without having any symptoms for several years, before the low back pain appears. Once the symptoms have appeared, the pain tends to worsen with time.
Treatment of low back pain is always medical first. It can be handled by the treating physician, often in collaboration with a rheumatologist, a rehabilitation specialist, or a pain specialist. This treatment will combine rest during episodes, analgesic and anti-inflammatorystrong> drugs (prescribed in incremental steps), physical therapy and sometimes infiltrations or even immobilization by back brace. The majority of back pain will respond favorably to these treatments, even if the episodes do not disappear completely. A more comprehensive assessment and an opinion from a spinal surgeon is indicated when the pain does not respond well to all of these treatments, and the symptoms, which have gone on for at least 6 to 12 months and often longer, are responsible for a significant disability in everyday life.
Principle of surgical treatment
Surgery for chronic low back pain due to spondylolisthesis can only be considered after failure of a medical treatment as long and as complete as possible. The principle of the surgery is to perform a fusion (arthrodesis) between the two unstable vertebrae, since the natural unions of these vertebrae are no longer sufficient. This bone fusion should take place once the slipped vertebra has been put back into proper position, so as not to allow a deformity of the back to develop, which could lead to premature degeneration of the discs above it.
Average hospitalization time
10 days (this is the duration most often reported).
Discharge can be directly to home or to a rehabilitation center for a 2- to 3-week stay. Transfer is by medical transport service in both cases. Management at the center will be multidisciplinary (rehabilitation specialist, pain specialist, physical therapist, ergotherapist). The total recovery period extends for 3 to 6 months following the surgery. Based on the severity of symptoms before the procedure, this period may last even longer. Recovery is not synonymous with bed rest. Physical exertion, carrying loads, and car trips must be limited during this period. Walking is often beneficial. Recurrence of pain during recovery is often the result of too much activity and will tend to disappear with rest. Follow-up consultations with your surgeon will be scheduled at regular intervals during the first two years after the surgery.