Spondylolisthesis – Is Back Surgery Necessary?

Those suffering from spondylolisthesis may not always require back surgery as their condition may remain asymptomatic of be manageable through more conservative means. Some patients with a slow development of the condition may need no surgical intervention as the body sometimes learns to accommodate the vertebral slippage and would actually be compromised more by the acute changes following decompression and spinal fusion. Similarly, those with congenital spondylolisthesis may have a spinal structure that has adapted to the deformity throughout life and needs no ‘correction’ as such. Where acute spinal trauma has occurred however, a patient’s body has not yet adapted to the new alignment and may be benefited by prompt back surgery to correct the spondylolisthesis. Traumatic spondylolisthesis can often be quite easily realigned through spinal fusion surgery and has usually had little impact on the other structures of the spine in terms of ligament or disc degeneration.

The sudden correction of spinal alignment following back surgery may create problems in those with spondylolisthesis caused by congenital dysfunction or gradual degeneration. Spinal hardware changes the stress applied to different structures in the spine and this can lead to bone fractures, hardware failure, or possible nerve injury following surgery. Decompression surgery may be performed without fusion if it looks likely to alleviate symptoms without contributing to further slippage of the vertebrae.

Back surgery for spondylolisthesis is not usually advantageous for adult patients with no symptoms, or whose symptoms are manageable using conservative treatment. Children with spondylolisthesis will also usually be able to manage their condition without the need for surgery, although those in pain or with progression of the forward movement of the vertebrae may need surgery to prevent the problem from worsening. Ensuring that children, and adults, are aware of the activities which could exacerbate the spondylolisthesis can prevent the need for back surgery in the future. Heavy lifting, gymnastics, football, diving, and competitive swimming or wrestling are inadvisable for most patients.

It is important to remember that many patients undergo unnecessary back surgery for conditions such as asymptomatic spondylolisthesis and suffer as a result of the surgery. Discussing the options, and the need for surgery, with a qualified and experienced spinal surgeon should help a patient to clarify their situation. Spondylolisthesis may be blamed for back and neck pain when there is actually an alternative aetiology, and back surgery to correct the spinal slippage is extremely unlikely in such cases to have a positive outcome of effectively relieve the patients’ symptoms. Abdominal distention and pain may be a result of surgery for spondylolisthesis using an anterior approach, and a small number of patients require revision surgery to address such complications. Others may suffer with leg and back pain to varying degrees following surgery, with some having an increase in pain compared to previous symptoms. Spinal fusion can also cause adjacent segment syndrome where degeneration progresses more rapidly at the vertebral levels above and below the area fused. Conversely, some patients may have such severe nerve damage prior to surgery that their recovery takes months or even years, with extensive physical therapy and rehabilitation required. In a small number of cases the nerve damage may be irrevocable and pain, numbness, or weakness can persist.

Standaert , C.J., Herring, S.A., Halpern, B., King, O., (2000), Spondylolysis, Phys Med Rehabil Clin N Am., Vol.11, No.4, pp.785-803.

Kalichman, L., Hunter, D.J., (2008), Diagnosis and conservative management of degenerative lumbar spondylolisthesis, Eur Spine J., Vol.17, No.3, pp.327-35.