Spondylolisthesis surgery is only recommended if all alternative treatments are found as ineffective, symptoms progress, and/or pain is so extreme that it significantly disrupts quality of life. Generally, non-surgical procedures are sufficient at relieving the symptoms of spondylolisthesis; however, there are times when spondylolisthesis surgery is necessary.
Factors for Spondylolisthesis Surgery
- Grade (level) of spondylolisthesis
- Overall health
- Neurological deficit (weakness or numbness and/or bowel or bladder dysfunction)
- Spinal curvature or deformity
- Nerve root entrapment or compression radicular pain
- Risk factors for failure of bones to fuse (pseudarthrosis)
Benefits/Risks for Spondylolisthesis Surgery
Spondylolisthesis surgery is used as a last resort due to the risks involved; however, the benefits could help a person diagnosed with severe spondylolisthesis. A successful surgical procedure will relieve pressure or compression of the affected nerves, help to prevent further slippage and continued nerve compression by stabilizing the vertebra with fusion, and restore spinal alignment.
The potential risks and complications involved are why surgery is done as a last resort. Listed below are just a few to consider:
- Hardware failure
- Pain continues even after surgery
- Adjacent segment degeneration
- Dural leak
- Nerve root damage
- General anesthetic risks (blood clots, pulmonary emboli, pneumonia, heart attack, and/or stroke)
While most of these risks and complications are rare, they are a possibility. Overall general health and lifestyle choices can increase these risks. These include but are not limited to:
- Multilevel fusions
- Rheumatoid arthritis
- Prior failed back surgery
Types of Spondylolisthesis Surgery
The type of surgery for spondylolisthesis you have will depend on your symptoms and your doctor. There is some indecision among surgeons as to which type is best; however, it is important as a patient to understand all of the options that are available to you.
There is a minimally invasive surgery that should be considered before all other options. Talk with your surgeon before accepting a more invasive procedure to find out why the minimally invasive procedure will not work for you. It is possible that the minimally invasive procedure is not an option in your case; however, you will want to ensure this decision by getting a second or even third opinion.
While there are invasive and minimally invasive surgeries, there are three surgical procedures that are based on the approach to the vertebral fusion. All three approaches can be used for invasive and minimally invasive surgeries. These approaches are:
- ALIF – Anterior (front) Lumbar Interbody Fusion
- PLIF – Posterior (back) Lumbar Interbody Fusion
- TLIF – Transforaminal (side) Lumbar Interbody Fusion
Open Back Surgery
If your surgeon feels it is necessary, it is possible to realign your spine. However, most will first try to take the pressure off the nerves to stabilize the spine. There are two main types of open back surgery. These are:
- Decompression Procedure
- Spinal Fusion
Decompression procedures, such as a laminectomy or laminotomy, are used to remove whatever spinal component is placing the pressure on your nerve root and spinal cord. This will then release the pressure on the nerves, which results in eliminating the source of pain.
A spinal fusion is often performed in conjunction with a decompression procedure. This happens because decompression involves removing the spinal components causing the pressure, which then creates an unstable spinal structure.
A spinal fusion will then be performed to insert a bone graft or some type of synthetic material into the area of your spine where the component was removed. Screws and rods are used to support the spine as it heals, which forces two or more vertebrae to permanently be fused together as one bone.
Minimally Invasive Surgery
This procedure is done through several tiny incisions instead of one big incision. Surgeons use microscopes and very small instruments for decompression and fusion. The minimally invasive surgery allows for less blood loss during surgery. Recovery time is much less because your surgeon will not have to cut as much into your muscles, ligaments, and tendons.
Sometimes surgeons will use techniques from the open back and the minimally invasive procedures together called a “mini-open” procedure. Pain does not have to be a constant in your life. If you have tried all the non-surgical treatments and still are in severe pain, spondylolisthesis surgery could be the answer for you.