Nonsurgical Treatment for Spondylolisthesis

Most people who have spondylolisthesis, a misalignment of the spine, find that nonsurgical treatments, such as physical therapy and bracing, relieve pain and improve function. Physicians at NYU Langone’s Spine Center work closely with experts at Rusk Rehabilitation to help you return to an active lifestyle as quickly as possible.

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During treatment, your doctor may take periodic X-rays of your spine to monitor the affected vertebra and ensure that the condition doesn’t progress. The risk of progression—which often means that the vertebra slips forward so much that it compresses nearby nerves—is higher in people under age 16 because the spine is still growing.

In adults who have degenerative conditions such as osteoarthritis of the spine or degenerative disc disease, spondylolisthesis may worsen as a result of progressive damage to the spine’s joints and discs. This can cause the vertebrae to become less stable.

Nonsurgical treatment can usually prevent the condition from progressing and relieve symptoms.

Activity Modification and Bracing

If certain sports or activities increase lower back pain, your doctor may recommend taking a break from them until the pain subsides. This doesn’t mean you must remain sedentary. Moderate, low-impact activities such as tai chi or swimming increase blood flow to the spine and can speed your recovery. 

Your doctor may also recommend wearing a back brace to support your lower back and prevent the spine from developing unusual curves. Orthotics specialists at NYU Langone can create a comfortable, custom-fit brace for you. Generally, doctors recommend wearing the brace any time you are not resting. Your doctor determines the right type of brace for you and how long you should wear it.

Physical Therapy

Physical therapy can relieve lower back pain, enabling you to return to sports and other activities. At Rusk Rehabilitation, physical therapists who specialize in helping people recover from spine injuries can teach you simple exercises to strengthen the muscles in your abdomen and back. Strong core muscles reduce the amount of stress the spine absorbs, creating an internal “brace” that supports and stabilizes the spine. 

Stretching muscles that support the spine can also relieve discomfort and reduce stress on the lower back. People with spondylolisthesis often have tight hamstrings, which run along the backs of the legs between the buttocks and knees. Our physical therapists can teach you stretching exercises that you can perform daily at home.

Our physical therapists create an exercise routine for you based on your symptoms and the results of diagnostic imaging tests, such as X-rays, to ensure that it is appropriate for your injury. 

Your doctor may recommend 6 to 12 weeks of physical therapy at Rusk Rehabilitation or at a facility near your home. Your physical therapist evaluates your progress every six weeks to determine whether further treatment is needed.

Pain Relief Medication

Inflammation in the spine and the surrounding soft tissues can cause irritation and swelling that worsens during movement, so your doctor may recommend over-the-counter nonsteroidal anti-inflammatory drugs, or NSAIDs. These medications reduce inflammation and alleviate pain, helping you remain active.

The most common NSAIDs are ibuprofen, naproxen, and aspirin. All are available without a prescription, and your doctor can recommend how to use them. If spondylolisthesis causes more serious pain that is not relieved by an over-the-counter NSAID, your doctor may prescribe a stronger medication.

Corticosteroid Injection

A corticosteroid injection delivers anti-inflammatory medication directly to the spine. Most of the time, an injection is recommended only after other nonsurgical treatments have failed to bring relief. Corticosteroids may provide long-term pain relief and can be injected directly into the epidural space, the fluid-filled area surrounding the spinal cord. 

These injections are performed after you are given local anesthesia. NYU Langone pain management specialists and radiologists use X-ray guidance to ensure the medication is injected precisely. The procedure typically takes less than 30 minutes.

Pain relief from injected steroids may last from a week to a year or even longer. However, they do not work for everyone. 

Steroid injections are most effective when used just before starting physical therapy, allowing you to practice strength-building exercises in the abdomen and back with less discomfort.

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