In a degenerative spondylolisthesis, one vertebrae slips forward on another and in the process may pinch a nerve root. This can result in sciatica on a repetitive process and may be extremely problematic and painful for patients on a daily basis. This is termed spinal stenosis. Pain may radiate down to the legs and feet and cause difficulty with ambulation, work ability, recreational activities, and hinder social efforts.

A fusion of the spine may considerably help if conservative measures fail to alleviate the pain. Conservative measures include pain management options that may be interventional pain management (epidural injections), pain medications, Scottsdale physical therapy, Phoenix chiropractic, or spinal decompression therapy.

During a spine fusion, the spine surgeon initially takes away the lamina, which is the bony spinal element that is situated over the spinal cord region. This is termed a laminectomy and serves to decompress the areas experiencing nerve pinching. An MRI done before the surgery will show the areas being pinched and where to focus the surgical efforts. There may be some additional findings during surgery, but taking a "we'll see what's going on when I get in there" approach is not the best.

The bone taken out is saved and then milled down and usually an additional substance is added to it. On the outside of the spine on each side, this bony material, called bone graft, is placed and the remaining bony areas on the spine are "roughed up" to encourage bony healing and hence a bony fusion. The spinal fusion will weld one level to another so that movement will no longer occur.

In many cases, screws and rods are placed in the vertebrae to stop movement between the affected levels. This hardware keeps the levels firmly in place while the bony fusion takes place. So basically you have the spinal decompression portion to free up pinched nerves and then the spinal stabilization part to prevent further slipping or instability.

The question of whether not to have surgery for isthmic spondylolisthesis is a very good one. Isthmic spondylolisthesis is a condition that occurs after a patient has a stress fracture which initially is spondylolysis on both sides of the spinal level, and then turns into a slippage of the vertebral body on the level below it. As soon as the beginning stress fracture happens, termed spondylolysis, the individual will often experience pain, however, surgery for spondylolysis itself is typically not a good idea.

Surgery could be necessary in unusual circumstances for spondylolysis, however, typically it is dealt with effectively with conservative management. If the stress fracture refuses to heal and eventually stops trying, then you may end up with the vertebral body slipping forward as the back part stays put, and what one sees is the vertebral body slipping ahead over the one below, termed spondylolisthesis.

In order to determine whether or not surgery would be indicated for the spondylolisthesis, a determination needs to be made as to the degree of slippage. A Grade 1 slip means the vertebral body slips between 0 and 25% compared to the vertebral body below it. A Grade 2 Slip means the vertebral body slipped forward twenty five to fifty percent and Grade 3 is seventy five to one hundred percent of one vertebral body over the one below. A Grade 5 is over one hundred percent, and it is actually called a spondyloptosis.

Studies have shown that by the time a patient is seen with a spondylolisthesis that has slipped and is symptomatic, the patients slippage has achieved 90% of that which you will ever slip. Research studies for isthmic spondylolisthesis have shown that spine surgery is indicated for slippages over a Grade 2. So if it's a Grade Three or Grade Four then surgery is indicated in order to alleviate the patient symptoms and prevent further slippage from occurring.

Whether or not to reduce the slip during surgery is controversial, however, what's not controversial is that the levels should be fused and the nerve roots being pulled should be decompressed.

If a patient has a Grade One or Grade Two slip, then surgery is indicated only if conservative AZ pain management treatment fails. This may include spinal bracing, TENS Units, physical therapy, phoenix chiropractic treatment, and pain management.

Spinal Degenerative Spondylolisthesis is an extremely common condition that results from spinal arthritis. One vertebra slips on another, and it becomes a mechanical problem that cannot be "fixed". It can actually be painless and just appear incidentally on x-rays. Or symptoms may include back pain along with buttock, hip, and/or leg pain.

Once the diagnosis of degenerative spondylolisthesis is made, what are the treatment alternatives? Here are 7 nonoperative pain management treatment options:

1. Ignore it
2. Phoenix Physical Therapy
3. Chiropractor Treatment
4. Spinal Decompression
5. Pain Medication
6. Interventional Pain Treatments
7. Bracing and TENS Unit

Ignoring the symptoms of degenerative spondylolisthesis is a treatment known as benign neglect. It's not a fatal condition and will not paralyze anyone, so if the symptoms are tolerable it is ok to simply deal with it until it rises to the level of concern. If one wonders whether or not there is a way to prevent the condition from getting worse, the answer is - not really.

There is some research that nutraceuticals like chondroitin sulfate and glucosamine may stave off arthritis that can result in the spondylolisthesis, but this is not a definite.

Physical therapy and arizona chiropractor treatment have been shown to be effective for back pain isues, especially when they come on acutely (under one month duration). It may be that your symptoms are an acute exacerbation and if treated with these options, may lessen back to a tolerable baseline.

Spinal decompression therapy is a revolutionary treatment option involving intermittent traction. It is very safe, FDA cleared, relatively painless, and extremely effective. Patients with degenerative spondylolisthesis are ok for the machine unless they have severe osteoporosis or post surgery with hardware.

Pain medications include NSAIDS, Tylenol, neuropathic medications, or narcotics. Over the counter medications according to the manufacturer's dosage specifications may control the pain very well such Aleve or ibuprofen. Neuropathic medications may include Neurontin or Lyrica. Narcotics should be given under the guidance of a doctor and should only be obtained by one physician.

Interventional pain treatments include facet injections (facet blocks), epidural injections, or radio frequency ablation. For pinched nerves or spinal arthritis, spinal injections have been shown to be significantly beneficial. They are very low risk and may have very high benefit.

Spinal bracing can be extremely helpful especially if the back pain is from instability with one segment shifting on the level below. A TENS Unit may keep symptoms at bay when utilized in moderation. It should be used according to your doctor's recommendations typically no more than an hour at a time with an hour off.

Surgery for degenerative spondylolisthesis should be performed as a last resort when all nonoperative options at an arizona pain center have failed.

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