Physio Penrith Spondylolithesis Treatment
Treatment of Spondylolithesis Back Pain at Sydney Muscle & Joint Physio Penrith
What is a degenerative spondylolithesis?
Degenerative spondylolisthesis is an acquired spinal condition in which there is anterior vertebral displacement without a disruption of the pars interarticularis. Degenerative spondylolisthesis usually occurs in the lumbar (low back) spine, more commonly at L4-L5 (4th and 5th lumbar vertebral levels). Spondylolisthesis is associated with the degenerative changes of ageing, such as intervertebral disc degeneration, ligamentous hypertrophy or buckling, and osteophyte proliferation.
What are the symptoms of a degenerative spondylolithesis?
Some people with degenerative spondylolisthesis in the low back are symptom-free, but these are the most common symptoms:
Central low back pain
Sciatica (leg pain)
Signs of neurological compromise- loss of reflexes, muscle weakness, loss of sensation
Tight hamstring muscles
Irregular gait or limp
An accurate diagnosis can be made from a lumbar x-ray, with further imaging including CT scan or MRI scan. Most radiologists, surgeons and physiotherapists use a grading scale called the Meyerding Grading System to classify the degree of vertebral slippage. This system is easy to understand, with the slips graded on the basis of the percentage that one vertebral body has slipped forward over the vertebral body below.
Grade I: 1-24%
Grade II: 25-49%
Grade III: 50-74%
Grade IV: 75%-99% slip.
Grade V: Complete slip (100%), known as spondyloptosis
In considering your management options one must consider the degree of slip and factors, such as irritable constant pain and neurological symptoms. Most cases of degenerative spondylolisthesis are grade I or II. As a general guideline, the more severe slips (grades III and above) are most likely to require surgical intervention.
What are the treatment options for degenerative spondylolithesis?
Treatment of degenerative spondylolithesis has long been a topic of debate, with both non-surgical and surgical options currently being utilised. In a recent analysis, 95,647 Medicare patients with a diagnosis of lumbar degenerative spondylolithesis, 40% were treated with corticosteroid injections, 37% were treated with physiotherapy, and only 22% were treated surgically. When considering surgical treatment data from the Spine Patient Outcomes Research Trial (SPORT) showed reoperation rate as high as 22% at 8 years after initial surgery. Nevertheless, surgical treatment of degenerative spondylolithesis with symptomatic spinal stenosis has been shown to be cost-effective with gain of 0.43 quality adjusted life years (QALYs), or greater for patients with multilevel disease.
Patients with mobile or low-grade spondylolisthesis, without neurological deficits, a trial of non-surgical therapy is certainly indicated and generally associated with good clinical outcomes at 1 year.
What treatment options do the physios at Sydney Muscle & Joint Clinic offer for degenerative spondylolithesis?
The physiotherapists and exercise physiologists at Sydney Muscle & Joint Clinic Penrith use guideline based, research supported interventions in the management of degenerative spondylolithesis. As we know patients with mobile or low-grade spondylolisthesis, without neurological deficits, will do better than a high-grade spondylolithesis.
Non-surgical modalities, including activity restriction, non-steroidal anti-inflammatory drugs (NSAIDs), and exercise based physiotherapy, remain the first-line threatments for patients with degenerative spondylolithesis. In one study of 145 patients managed with non-surgical interventions, 76% of patients without neurological deficits remained without asymptomatic at 10 years. However, 83% of patient that did have neurological deficits experienced progression of symptoms over 10 years. Progression of spondylolisthesis was not correlated with progression of symptoms.
The well-known SPORT study also included a non-surgical cohort. These non-surgically managed patients with degenerative spondylolithesis had better outcomes if they had a grade I slip (versus grade II) or had a hypermobile slip (versus a stable slip).