Nonoperative
1. Introduction
Indications
Asymptomatic patients should be observed and are not surgical candidates unless:
- Progressive listhesis
- High grade spondylolisthesis
Activity modification
Activity modification is recommended during painful episodes.
2. Physical therapy
A course of physical therapy focussing on core muscle strengthening (erector spinae muscle, psoas, and rectus abdominis) is the key to conservative treatment.
3. Pain management
Adjuvant medical treatment consisting of anti inflammatories, muscle relaxants may alleviate acute exacerbation of pain.
For children orthotic can also alleviate pain. A course of 6-12 weeks of a TLSO with thigh extension has been shown to be effective in pain relief.
A pars block consisting of local anesthetic (marcain) and steroids injection into / around the pars articularis has been shown to decrease pain. This can also be a diagnostic procedure confirming patients actual low back pain originates from the spondylolisthesis/spondylolysis.
