Surgery May Be Best for Degenerative Spondylolisthesis
Conservative (nonsurgical) care or surgery: which is better for patients with degenerative spondylolisthesis? In this condition, one of the vertebrae slips forward over the one below it. Back and leg pain and difficulty walking are common symptoms of this problem.
In the aging adult, spondylolisthesis and spinal stenosis often occur together. Stenosis refers to a narrowing or closing of an opening. When the bone moves forward, the spinal canal narrows and the nearby tissues and nerves become irritated and painful. This is because they are pinched or compressed by the narrowing.
So far, there isn't one best treatment for everyone with this condition. Conservative care with antiinflammatory drugs or pain relievers is usually tried first. If that doesn't work, then physical therapy and/or epidural steroid injections are tried. Surgery to relieve the pressure on the nerve tissue may be the final treatment choice.
The results of a recent randomized controlled trial (RCT) were compared to patients who were allowed to chose their own treatment path. RCT refers to the fact that patients were assigned to a treatment group randomly and not based on their symptoms or preferences.
Measures of outcomes included pain, physical function, and general health. Patients in both groups made moderate progress. There were no big differences in results between the surgical and nonsurgical patients.
However, when the data was combined for the RCT group and the self-selected treatment group, then surgery was the better treatment option. Patients who had surgery made more progress in treatment than those who had conservative care.
Surgery was linked with less pain, better function, and decreased disability. Seventy-five per cent of the surgical group said they had major improvement. This was compared with only 25 per cent in the conservative care group.
Some experts who reviewed the findings still question how accurate it is to say that surgery is the preferred treatment. There were many patients in both groups who crossed over to the other group. For example, patients in conservative care decided to have surgery after all. And some patients scheduled for surgery cancelled the operation. They went to physical therapy instead.
Many more questions were raised than were answered by this study. More study is still needed before a final decision can be made. It may be that some patients will do better with one choice over the other. Finding the factors to predict treatment outcome is the next step.
SPORT on Degenerative Spondylolisthesis. In The BACK Letter. August 2007. Vol. 22. No. 8. Pp. 88-89.