Nonsurgical Treatment for Isthmic Spondylolisthesis

The majority of people with isthmic spondylolisthesis are successfully treated with non-surgical treatment options, which can effectively manage symptoms and improve quality of life.¹Studnicka K, Ampat G. Lumbosacral Spondylolisthesis. [Updated 2022 Sep 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560679/^,2Mohile NV, Kuczmarski AS, Lee D, Warburton C, Rakoczy K, Butler AJ. Spondylolysis and isthmic spondylolisthesis: a guide to diagnosis and management. J Am Board Fam Med. 2022;35(6):1204-1216. doi:10.3122/jabfm.2022.220130R1

The goals of non-surgical treatments are to alleviate pain and promote healing of the pars interarticularis defect in the affected segment.²Mohile NV, Kuczmarski AS, Lee D, Warburton C, Rakoczy K, Butler AJ. Spondylolysis and isthmic spondylolisthesis: a guide to diagnosis and management. J Am Board Fam Med. 2022;35(6):1204-1216. doi:10.3122/jabfm.2022.220130R1

Success Rates of Non-Surgical Treatments for Isthmic Spondylolisthesis

Studies have shown that about 82% to 85% of young individuals with low grade isthmic spondylolisthesis can return to pain-free, unrestricted activities with non-surgical treatment.¹Studnicka K, Ampat G. Lumbosacral Spondylolisthesis. [Updated 2022 Sep 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560679/^,2Mohile NV, Kuczmarski AS, Lee D, Warburton C, Rakoczy K, Butler AJ. Spondylolysis and isthmic spondylolisthesis: a guide to diagnosis and management. J Am Board Fam Med. 2022;35(6):1204-1216. doi:10.3122/jabfm.2022.220130R1

Exploring Treatment Options for Isthmic Spondylolisthesis: A Comprehensive Guide

Common non-surgical interventions for isthmic spondylolisthesis are discussed below.

Physical therapy and exercise

Physical therapy plays a crucial role in the non-surgical management of isthmic spondylolisthesis. Stretching and strengthening the muscles around the spine helps provide support and reduce stress on the affected vertebrae.

Specific categories of exercises commonly recommended include:

• Core-strengthening exercises: Targeting the deep abdominal and multifidus muscles, these exercises help stabilize the spine and reduce pain.¹Studnicka K, Ampat G. Lumbosacral Spondylolisthesis. [Updated 2022 Sep 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560679/
• Flexibility exercises: Stretching exercises can improve range of motion and alleviate muscle tightness associated with spondylolisthesis.³Ferrari S, Vanti C, O'Reilly C. Clinical presentation and physiotherapy treatment of 4 patients with low back pain and isthmic spondylolisthesis. J Chiropr Med. 2012;11(2):94-103. doi:10.1016/j.jcm.2011.11.001
• Flexion-based exercises: Exercises that include forward-bending postures help improve healing and prevent exacerbation of the condition.¹Studnicka K, Ampat G. Lumbosacral Spondylolisthesis. [Updated 2022 Sep 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560679/
• Low-impact aerobic exercises: Activities such as walking, swimming, cycling promote cardiovascular health without placing excessive strain on the spine.⁴Vanti C, Ferrari S, Guccione AA, Pillastrini P. Lumbar spondylolisthesis: STATE of the art on assessment and conservative treatment. Arch Physiother. 2021;11(1):19. Published 2021 Aug 9. doi:10.1186/s40945-021-00113-2

Postural training and activity modification (such as avoiding backward bending activities) is also a part of a physical therapy program.¹Studnicka K, Ampat G. Lumbosacral Spondylolisthesis. [Updated 2022 Sep 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560679/

An experienced physical therapist can help formulate a personalized exercise program to strengthen the core muscles, improve flexibility, and stabilize the spine.

Pain management

Pain management is an essential aspect of non-surgical treatment for isthmic spondylolisthesis.

• Over-the-counter pain medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) and muscle relaxing medications may help reduce inflammation and alleviate pain.⁵Burton MR, Dowling TJ, Mesfin FB. Isthmic Spondylolisthesis. [Updated 2022 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441846/ It is important to consult a healthcare professional before starting any medication regimen.
• Heat and cold therapy: Applying heat or cold packs to the affected area can help reduce pain and inflammation.⁶McDonald BT, Hanna A, Lucas JA. Spondylolysis. [Updated 2023 Jan 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK513333/
• Massage therapy: Massage techniques delivered by an experienced and licensed therapist can help relax tight muscles, improve circulation, and reduce pain.

Bracing

In certain cases, a back brace, such as a thoracolumbosacral or lumbosacral brace, may be recommended to provide support and stability to the spine.¹Studnicka K, Ampat G. Lumbosacral Spondylolisthesis. [Updated 2022 Sep 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560679/ A back brace helps limit the movement of the affected vertebrae, reducing pain and preventing further slippage.

See Using a Back Brace for Lower Back Pain Relief

The brace is typically worn during activities that may exacerbate symptoms, such as sports or heavy lifting. A physician helps determine the type of brace and duration of use based on the individual's specific condition and needs.

Preventing Isthmic Spondylolisthesis: Lifestyle Changes and Ways to Reduce Risks

While it may not be possible to prevent isthmic spondylolisthesis entirely, certain lifestyle changes can help reduce the risk of developing this condition. By adopting healthy habits and making mindful choices, one can potentially minimize the likelihood of developing this condition.

Here are some preventive measures to consider:

• Maintaining good posture. Practicing proper posture when sitting, standing, and lifting heavy objects can help alleviate strain on the spine and reduce the risk of injury.
• Engaging in regular exercise. Physical activity and exercise that strengthen the core and back muscles can enhance the overall stability of the spine and prevent a flare up of pain. Activities like swimming, walking, and yoga can be beneficial.
• Avoiding overuse and repetitive movements. It is advisable to prevent prolonged or repetitive movements that strain the spine. For occupations that involve such movements, taking regular breaks and practicing ergonomic techniques are helpful.
• Using supported lifting techniques. When lifting heavy objects, using the hips and core instead of the back can help minimize the strain on the spine.
• Maintaining a healthy weight. Excess body weight places added stress on the spine. Maintaining a balanced diet and incorporating regular exercise can help manage weight and reduce the strain on the back.
• Prioritizing spinal health. Regular check-ups with healthcare professionals specializing in spine care can help detect any potential issues early on and allow for timely intervention.

It's always advisable to consult with a physician with specialty spine training for personalized guidance based on individual health needs.