Frequently Asked Questions About Spondylolisthesis

Wear and tear of the vertebrae over time, as well as sports injuries, accidents, and tumors, may cause lumbar spondylolisthesis. Lumbar spondylolisthesis may also occur after some difficult births. Aging is one of the important causes of lumbar spondylolisthesis, because vertebrae that have been worn down over many years, together with increasingly frequent pain, may turn lumbar slippage into a serious problem.

Lumbar spondylolisthesis is commonly seen in childhood and after middle age. The form seen in childhood is congenital and occurs at an early age due to deficiency in the posterior supporting structures. It usually involves slippage of the lowest vertebra where the lower back joins the pelvis (L5-S1). The adult type that develops after middle age more commonly occurs when the fourth lumbar vertebra slips over the lowest lumbar vertebra (L4-L5).

The public shows interest in treatments applied by non-physicians for lumbar spondylolisthesis. However, this method is known in medicine as "manipulation therapy" and is performed only by physicians. Even when performed by a physician, this method must be applied with extreme care. Otherwise, during the pulling process, the nerves exiting the spinal cord may become compressed between the vertebrae, causing disorders that are difficult to repair and even paralysis. In many patients, lower back pain may improve with simple medications or bed rest. The fact that this method appears successful in some patients when applied by non-medical persons does not eliminate its risks. The first principle in medical interventions is not to harm the patient while trying to help. For this reason, it should be especially emphasized that having the lower back pulled by non-medical persons is extremely harmful.

Definitely not. In patients with mild slippage, non-surgical treatments are started first. Sometimes we simply observe patients without giving any treatment at all.

Medication is used in patients who have pain and muscle spasm. Activities are reduced so the lower back can rest, and efforts are made to relieve the muscle spasm. If complaints continue, a lumbar brace may also be tried. By limiting spinal movements, the brace may also help relieve the spasm and reduce pain.

Steroid injection may be applied to the lower back of patients whose complaints continue despite medication, activity restriction, and use of a lumbar brace. The injection is administered into the epidural space around the lumbar nerve roots. These injections reduce pain and swelling. However, they generally provide only temporary improvement.

A good rehabilitation program may strengthen the muscles around the lower back and lengthen the short and tight muscles around the hips, helping the slipped vertebra become more stable. Throughout rehabilitation, patients continue to receive rest, medication, and rehabilitation treatments under the supervision of a physician.

We recommend surgery when the slippage is severe and the complaints cannot be improved with non-surgical treatment methods. Worsening of walking, changes in bowel and bladder functions, and irreversible deterioration in nerve functions are other reasons for surgery.

In general, the surgery performed is fusion surgery, in which the slipped vertebra is fixed to the vertebra below it with screws and fused. At the same time, the nerves under pressure are decompressed. Sometimes, in order to increase the height of the spaces where the nerve roots exit, a cage may also be placed between the vertebral bodies. This cage is also filled with bone and enables fusion between the vertebral bodies.

This is a fusion surgery, in other words, a procedure in which the slipped vertebra is fused to the vertebra below it by eliminating the joints in between. Therefore, the movement belonging to that joint disappears after surgery. However, patients may still have nearly normal lower back movement by using the adjacent vertebral joints above and below.

The aim in surgery is to fuse the smallest possible number of vertebrae together, preferably only two. If there is a serious problem such as degeneration, spinal canal narrowing, or herniation in the upper or lower joints, more than two vertebrae may need to be fused together. However, in that case, a noticeable decrease in lower back movement occurs. The surgeon performing the operation should try to preserve lower back movement as much as possible.

We discharge patients on the 3rd day after surgery. After the operation, I use a special brace for four weeks in my patients to support the lower back muscles. Fusion in the lumbar bones is completed within 6 to 12 months. During this period, we restrict bending forward and backward.