Column The Different Treatments Available for People with Spondylolisthesis Depending on the Symptoms and Severity of their Condition
November 24, 2023
Sometimes, an abnormality occurs in the joints of the spine known as the intervertebral joints or in the intervertebral discs, and the bones become misaligned. This condition is called spondylolisthesis.
Symptoms of Lumbar Spondylolisthesis
Mild cases of lumbar spondylolisthesis may be asymptomatic, and it is not uncommon to find that lumbar spondylolisthesis has progressed when symptoms first appear, and the patient is examined.
The main symptoms of lumbar spondylolisthesis are back pain, pain and numbness in the buttocks and lower extremities. The appearance of symptoms depends on the degree of instability of the slip, the degree of degeneration of the intervertebral or isolated area, and the location and degree of nerve compression.
One of the most common symptoms of spondylolisthesis is numbness and pain in the buttocks and lower extremities that appears while walking. Intermittent claudication, which allows the patient to walk again after a short break, is common.
Degenerative spondylolisthesis is often associated with spinal stenosis, and symptoms of stenosis such as leg pain, numbness, intermittent claudication, and urinary problems can be present.
The different levels of severity for spondylolisthesis
Lumbar spondylolisthesis is classified into four grades according to the degree of slip of the lower vertebrae.
・Grade 1: 0 to 25%
・Grade 2: 25% to 50%
・Grade 3: 50 to 75%.
・Grade 4: 75% to 100%.
A grade 3 or higher spondylolisthesis has a higher chance to be associated with neurological symptoms, so surgical intervention is likely to be recommended.
Conversely, if the spondylolisthesis is at grade 2 or higher, but the main complaint is low back pain alone, conservative treatment is often the answer.
The different treatment for spondylolisthesis
The treatment of spondylolisthesis is generally conservative therapy or surgery.
When symptoms are mild, conservative therapy is the first step to be attempted.
In the case of conservative treatment, corsets and other devices are used to reduce the strain on the back muscles and reduce the burden on the nerves. Anti-inflammatory painkillers and blocked injections are also used to alleviate the symptoms.
In addition, stretching and strength training in the vicinity of the lower back, especially around the abdominal muscles, may be performed during rehabilitation.
Surgery is suggested when symptoms do not improve with conservative treatment and are dragging on, or when pain and numbness worsen, and quality of life deteriorates.
The most common surgical procedures for spondylolisthesis are lumbar fusion and posterior lumbar decompression.
In fusion surgery, the part of the spine that is compressing the nerve is removed, and bone grafts are made to maintain the spine in place.
Under general anesthesia, an incision of approximately 4 to 5 cm is made in the back, both the intervertebral joint on the symptomatic side and the intervertebral disc are removed, and the patient’s own bone material, or bone obtained from a bone bank is grafted to the disc and is held in place using internal fixation materials (such as screws and rods) to the upper and lower vertebral bodies.
Fixation of the slipped lumbar vertebrae helps stabilize the spine, which has become unstable, and prevents further slippage.
Lumbar fusion requires approximately two weeks of hospitalization and three months of postoperative rest.
This surgery is covered by health insurance, and the surgical cost (30 percent of the total cost) is approximately between 600,000 to 850,000 yen.
*In addition to the treatment cost, hospitalization costs (basic hospitalization fee, meals, etc.) will also be charged. The total cost may end up being way more than 1,000,000 yen in total.
・Posterior lumbar decompression
In posterior decompression surgery, an incision of approximately 3 cm is made in the lumbar region under general anesthesia, and the spinal canal is widened by removing the vertebral arch while being checked up in real time under fluoroscopy.
It may be performed alone or in combination with a fusion procedure for a slipped vertebra.
In decompression surgery, the bone slips and the nerve is compressed. When combined with fusion, it can also serve to stabilize the spine.
This surgery also requires hospitalization, which is approximately one week for decompression surgery alone.
The surgery is covered by insurance and costs between 250,000 and 400,000 yen (30% of the total cost). In addition to the treatment cost, hospitalization costs (basic hospitalization fee, meals, etc.) will also be incurred.
The treatment at our clinic – The Cellgel Method
Recent research indicates that intervertebral disc degeneration is a factor in causing spondylolisthesis. *1
That is why we believe that prevention of spondylolisthesis cannot be achieved without first repairing the degenerated intervertebral disc. At our clinic, we perform the Cellgel method on spondylolisthesis caused by disc degeneration.
* ReferenceNo 1: I. I. Akkawi, H. Zmerly. Degenerative Spondylolisthesis: A Narrative Review. Acta Biomedica, vol. 92, No.6, 2021.
The Cellgel procedure at our clinic provides a radical treatment by injecting a drug that fills the cracks in the disc, which then becomes a gel that replaces the cracks. It is characterized by the fact that the volume of the disc is not reduced, and the drug remains in the disc as a gel implant after treatment, thus preserving the disc.
Unlike conventional surgery, the Cellgel procedure does not involve incisions, so there are fewer postoperative risks.
The hospital stay is only half a day, and you can walk home on the same day of treatment.
The Cellgel procedure is an out-of-pocket treatment, and costs 1,320,000 yen (100% of the total cost) for a single disc.
If you are suffering from back pain or have been diagnosed with spondylolisthesis, please consider having a consultation at our clinic.