Surgery for Spondylolisthesis in Adults

Although nonsurgical treatment is often successful, sometimes surgery is required to relieve the symptoms of spondylolisthesis and prevent the condition from worsening.

Specialists at NYU Langone may recommend surgery for people with spondylolisthesis whose chronic back pain is not relieved by nonsurgical methods. Surgery may also be an option if a vertebra has slipped forward so much that a person’s posture is affected, a vertebra continues to slip forward despite nonsurgical treatment, or changes in the alignment of the spine affect posture and function. 

At NYU Langone’s Spine Center, your surgical team may include a neurosurgeon or an orthopedic surgeon, as well as radiologists and anesthesiologists who specialize in the spine. 

These experts collaborate to determine the most effective and least invasive approach to spine surgery based on how far the vertebra has slipped and the severity of your symptoms. The goal of surgery is to eliminate pain, relieve pressure from a pinched nerve, and protect the spine and nerves from further damage. Spine surgery requires general anesthesia.

Pars Repair

In this procedure, a surgeon stabilizes the fractured portion of the vertebra. He or she uses small wires or screws to join both sides of the fractured bone and secure the vertebra in place. This prevents the fracture from progressing and keeps the vertebra from slipping forward.

If the fractured part of the bone is very weak and needs reinforcement to heal fully, the surgeon may use a bone graft, a piece of tissue from another part of the body, to strengthen the affected bone and help it heal.

Spinal Decompression

Decompression is a technique that relieves pressure on nerves traveling through openings in the spinal column. If a nerve in the lower back is pinched as the result of a slipped vertebra, a person may experience numbness, tingling, or pain that radiates through the back or legs. Relieving pressure on the nerve root can alleviate pain and improve function in the spine.

Our surgeons may use one of several techniques to free a pinched nerve. They may remove part or all of the lamina, the bony roof of a vertebra, removing pressure on the nerve and giving it more space. This is called a laminectomy. 

Surgeons may also enlarge the opening in the spinal canal through which nerve roots travel to other parts of the body. This opening is called the foramen, and the surgical procedure is called a foraminotomy. 

A third type of decompression allows surgeons to remove part or all of a spinal disc—a thick piece of cartilage that cushions the vertebrae—if it slips out of place and compresses a nerve or the spinal cord. This is called a discectomy.

Any or all three of these decompression techniques may be required during surgery for spondylolisthesis.

Spinal Fusion

Surgeons almost always perform spinal fusion for spondylolisthesis. Spinal fusion stabilizes the spine by permanently joining two vertebrae, eliminating movement between them. Typically, bone grafts are placed between vertebrae to help them fuse together. In time, new bone grows over the graft. A surgeon also places small metal screws and rods into the spine to hold the vertebrae together while they heal and fuse.

What to Expect After Spinal Surgery

Most people remain in the hospital for one or more days so doctors and nurses can monitor the spine while it begins to heal.

In the days immediately after surgery, pain management specialists ensure that you have the medication you need to remain comfortable while you recover. In addition, a physiatrist, a doctor who specializes in rehabilitation, assesses your mobility. Many people are able to stand or walk the day after surgery, although movement may be minimal at first. Older patients may need more time to recover. 

Most people are able to walk and go home within one week of surgery. Some people, however, may require additional care and assistance after leaving the hospital. NYU Langone doctors can refer you to appropriate at-home or inpatient support services as needed.

For 8 to 10 weeks following surgery, physical activity should be limited to gentle, low-impact movements as the spine fuses and heals. Total bed rest is not recommended, though. Daily walking and moving around can help speed recovery and prevent complications, such as a blood clot condition known as deep vein thrombosis

Physical therapy usually begins 10 to 12 weeks after surgery. The goal is to strengthen core muscles and improve flexibility and movement. For the best results, physical therapy should continue for one year after surgery. 

Follow-up appointments with your surgeon occur at least every three months for the first year after surgery to ensure the fusion heals correctly. An X-ray is usually taken during these appointments so doctors can confirm that the spine is stable and the nerves are decompressed.

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