Degenerative Spondylolisthesis Treatment

As a general guideline, nonsurgical treatments are tried first for managing degenerative spondylolisthesis. 

If a medical emergency, such as bowel or bladder incontinence is present, surgical management is considered.  

Nonsurgical treatments are essentially divided into 6 categories, and depending on the grade of spondylolisthesis and the severity of signs and symptoms, a combination of treatments may be used. 

Rest and Pain-Relieving Medication

During the initial stages of the condition, physicians generally advise relative rest for 1-2 days and a short course of over-the-counter (OTC) and/or prescription medication to relieve symptoms.¹Kalichman L, Hunter DJ. Diagnosis and conservative management of degenerative lumbar spondylolisthesis. Eur Spine J. 2008 Mar;17(3):327-335. doi: 10.1007/s00586-007-0543-3. Epub 2007 Nov 17. PMID: 18026865; PMCID: PMC2270383.

Common oral medications that may help manage degenerative spondylolisthesis signs and symptoms are¹Kalichman L, Hunter DJ. Diagnosis and conservative management of degenerative lumbar spondylolisthesis. Eur Spine J. 2008 Mar;17(3):327-335. doi: 10.1007/s00586-007-0543-3. Epub 2007 Nov 17. PMID: 18026865; PMCID: PMC2270383.^,2Ko S, Kim S, Kim J, Oh T. The Effectiveness of Oral Corticosteroids for Management of Lumbar Radiating Pain: Randomized, Controlled Trial Study. Clin Orthop Surg. 2016 Sep;8(3):262-7. doi: 10.4055/cios.2016.8.3.262. Epub 2016 Aug 10. PMID: 27583108; PMCID: PMC4987309.:

• Acetaminophen 
• Non-steroidal anti-inflammatory drugs (NSAIDs)
• Aspirin 
• Opioids and muscle relaxants 
• Nerve pain medications such as gabapentin or pregabalin 
• Oral steroids

Since most individuals with degenerative spondylolisthesis belong to the older age group, medications such as NSAIDs are avoided due to the potential risk of gastrointestinal irritation.¹Kalichman L, Hunter DJ. Diagnosis and conservative management of degenerative lumbar spondylolisthesis. Eur Spine J. 2008 Mar;17(3):327-335. doi: 10.1007/s00586-007-0543-3. Epub 2007 Nov 17. PMID: 18026865; PMCID: PMC2270383.

If it is necessary to take an NSAID, cyclooxygenase (COX)-2 selective agents, such as celecoxib, may be prescribed as they cause less gastrointestinal irritation.¹Kalichman L, Hunter DJ. Diagnosis and conservative management of degenerative lumbar spondylolisthesis. Eur Spine J. 2008 Mar;17(3):327-335. doi: 10.1007/s00586-007-0543-3. Epub 2007 Nov 17. PMID: 18026865; PMCID: PMC2270383.

Before taking any medication checking liver and kidney function is advisable.¹Kalichman L, Hunter DJ. Diagnosis and conservative management of degenerative lumbar spondylolisthesis. Eur Spine J. 2008 Mar;17(3):327-335. doi: 10.1007/s00586-007-0543-3. Epub 2007 Nov 17. PMID: 18026865; PMCID: PMC2270383.

Read more about Medications for Back Pain and Neck Pain

Physical Therapy for Degenerative Spondylolisthesis

Physical therapy for degenerative spondylolisthesis includes a focus on carefully and progressively strengthening and stabilizing the lower back through flexion-based and strengthening exercises.¹Kalichman L, Hunter DJ. Diagnosis and conservative management of degenerative lumbar spondylolisthesis. Eur Spine J. 2008 Mar;17(3):327-335. doi: 10.1007/s00586-007-0543-3. Epub 2007 Nov 17. PMID: 18026865; PMCID: PMC2270383.

See Lumbar Spine Stabilization Exercises

The goals of physical therapy and exercise in treating degenerative spondylolisthesis are to¹Kalichman L, Hunter DJ. Diagnosis and conservative management of degenerative lumbar spondylolisthesis. Eur Spine J. 2008 Mar;17(3):327-335. doi: 10.1007/s00586-007-0543-3. Epub 2007 Nov 17. PMID: 18026865; PMCID: PMC2270383.:

• Reduce pain 
• Improve range of motion 
• Strengthen and stabilize the soft tissues of the spine 
• Improve function and endurance

Physical therapy typically starts under the guidance of a physical therapist followed by a longer-term home program.

See Physical Therapy for Low Back Pain Relief

Spinal Manipulation for Degenerative Spondylolisthesis

Studies have shown short-term improvement in degenerative spondylolisthesis pain through manual manipulation provided by appropriately trained health professionals.¹Kalichman L, Hunter DJ. Diagnosis and conservative management of degenerative lumbar spondylolisthesis. Eur Spine J. 2008 Mar;17(3):327-335. doi: 10.1007/s00586-007-0543-3. Epub 2007 Nov 17. PMID: 18026865; PMCID: PMC2270383.

Read Understanding Spinal Manipulation

Lumbar Bracing for Degenerative Spondylolisthesis

The use of a lumbosacral brace or corset has been shown to improve degenerative spondylolisthesis symptoms while walking and performing daily activities.¹Kalichman L, Hunter DJ. Diagnosis and conservative management of degenerative lumbar spondylolisthesis. Eur Spine J. 2008 Mar;17(3):327-335. doi: 10.1007/s00586-007-0543-3. Epub 2007 Nov 17. PMID: 18026865; PMCID: PMC2270383.

A brace also limits spinal rotation, which may help people who have pain due to impingement of spinal nerves as they exit the spine (foraminal stenosis).¹Kalichman L, Hunter DJ. Diagnosis and conservative management of degenerative lumbar spondylolisthesis. Eur Spine J. 2008 Mar;17(3):327-335. doi: 10.1007/s00586-007-0543-3. Epub 2007 Nov 17. PMID: 18026865; PMCID: PMC2270383.

See Using a Back Brace for Lower Back Pain Relief

Epidural Steroid Injections for Degenerative Spondylolisthesis

Epidural steroid injections deliver a corticosteroid medication, such as methylprednisolone, around the cauda equina nerves and spinal nerve roots in the lower spine. These injections aim to relieve severe pain, especially leg pain related to radiculopathy and neurogenic claudication, and improve function in the lower back and legs.¹Kalichman L, Hunter DJ. Diagnosis and conservative management of degenerative lumbar spondylolisthesis. Eur Spine J. 2008 Mar;17(3):327-335. doi: 10.1007/s00586-007-0543-3. Epub 2007 Nov 17. PMID: 18026865; PMCID: PMC2270383.

Studies have shown that epidural steroid injections are effective in reducing pain and increasing lower back function in almost 50% of people with degenerative spondylolisthesis.¹Kalichman L, Hunter DJ. Diagnosis and conservative management of degenerative lumbar spondylolisthesis. Eur Spine J. 2008 Mar;17(3):327-335. doi: 10.1007/s00586-007-0543-3. Epub 2007 Nov 17. PMID: 18026865; PMCID: PMC2270383.

The length of time that a lumbar epidural injection can be effective is variable. The treatment may provide no benefit, short- or long-term benefit.¹Kalichman L, Hunter DJ. Diagnosis and conservative management of degenerative lumbar spondylolisthesis. Eur Spine J. 2008 Mar;17(3):327-335. doi: 10.1007/s00586-007-0543-3. Epub 2007 Nov 17. PMID: 18026865; PMCID: PMC2270383.

See Epidural Steroid Injections: Risks and Side Effects

Epidural steroid injections may provide a good alternative to surgery in older individuals with other medical conditions.¹Kalichman L, Hunter DJ. Diagnosis and conservative management of degenerative lumbar spondylolisthesis. Eur Spine J. 2008 Mar;17(3):327-335. doi: 10.1007/s00586-007-0543-3. Epub 2007 Nov 17. PMID: 18026865; PMCID: PMC2270383.

Activity Modification

Modifying certain types of daily activities can help take pressure off the spinal nerve roots in the degenerated segment. If activity modification substantially reduces the pain and symptoms, it could serve as an acceptable way to manage degenerative spondylolisthesis in the long term. 

Activity modification for degenerative spondylolisthesis generally includes:

• Avoiding standing or walking for long periods
• Avoiding activities that require bending backward

Simple self-care can assist in this approach, such as the application of cold packs or heating pads and/or taking over-the-counter pain relievers before walking or doing any strenuous activity.

For individuals who prefer to be more active, stationary biking is a reasonable option, as exercise in the sitting position is typically more tolerable. Another option is pool therapy – exercising in a swimming pool. The buoyancy of the water supports the body’s weight and creates an environment to exercise with less stress on the joints and muscles.