Spondylolisthesis - Treatment

Physical therapy and rehabilitation:It should not be initiated until after a rest period and once the pain with daily activities decreased. Physical regimes reduce stress by extension of the lumbar spine and promotes nonlordotica position.Consisting of abdominal muscle stretching exercises, wearing harnesses and strengthening the fascia lombodorsale. Tijarea with ortoza toracolombosacrala offers relief for those who do not respond to rest or daily activities which cause symptoms. This type of rod is effective for patients with less than 50% slip. The rod is worn for 3-6 months. If slip is below 50%, but symptomatic therapy is recommended noninterventionala: stretching exercises, antilordotica rod, changing activities. If the pain continues to recommend spinal fusion.
Surgical therapy:Surgery is indicated for skeletally immature patients with sliding more than 30-50% because they are at risk of progression to persistent neurological deficit and pain. If the pain resolves in 6-12 weeks not with rest and immobilization is recommended surgery.Low-grade spondylolysis with spondylolisthesis can be treated noninterventional. Options for intervention include direct repair of the defect spondilolitic, fusion, and fusion and reduction vertebrectomie. The best results are seen in patients with lithic defect. Disc degeneration is a relative contraindication. Sliding more than 2 mm decrease surgical repair success.
Fusion at the affected site is the criterion standard for surgical treatment for most patients who fail conservative therapy. Fusion in situ is recommended for patients with low grade spondylolisthesis, persistent symptomatic and for those who are not candidates for repair the defect.
Decompression and fusion are performed in cases of compression of the dura in the presence of bowel or bladder dysfunction or significant motor deficits. Decompression is never performed without concomitant fusion. Pedicles screw fixation allows rapid mobilization and early outpatient after decompression and fusion. Fixation may be beneficial in the repair and prevent sliding pseudoartrozelor progressive.
Spondylolisthesis reduction procedure is performed by closed or open. Reduction of lumbosacral kyphosis correction and serves to reduce sagittal translations. Vertebrectomia can be used to treat spondiloptoza and as an alternative to reduction or fusion in situ.Postoperative neurological deficit rate is 25%.
Prognosis:In general, patients with grade 1 or 2 are treated isthmic slip conservative therapy. Patients can return to work by reducing pain and previous activities. Apply for a home exercise regimen. Long-term evolution is favorable, especially if not associated with neurological impairment. Morbidity is represented by persistent back pain or nerve incarceration. Since disc degeneration is accelerated in the spondylolisthesis may occur discogenica pain.Arthritic degenerative spondylolisthesis produces characteristic symptoms worsen with age.
The most common complication of spondylolisthesis of any type is incarceration nerve / radiculopathy in the disease. Spinal stenosis and ponytail syndrome can occur if the slip is significant.High-grade spondylolisthesis has a variable prognosis from back pain. Surgery without improvement in claudication and radicular symptoms. Discogenica Lumbar pain can cause discomfort.Patients with degenerative disease tend to experience pain in joints derived from girls. Surgical decompression for neurologic compromise is a high success rate in relieving symptoms of lower extremity.