Nonsurgical Treatment of Spondylolisthesis in Pediatric Patients

Abstract

Spondylolisthesis occurs when a vertebra slips anteriorly relative to the vertebra below it. This chapter defines what is known about the natural history of this condition as well as delineating the benefits of specific nonsurgical interventions. These slips occur because of a defect in the posterior elements of the spine which can be either dysplastic or traumatic in nature. Most of what is written about spondylolisthesis is clumped together with spondylolysis, but this chapter uniquely looks specifically at spondylolisthesis separately. The natural history studies have all shown a very benign prognosis for low-grade spondylolisthesis, when the slip is less than 50% of the width of the vertebra; the vast majority of these patients either are asymptomatic or have successful control of their back pain symptoms with physical therapy and other nonoperative interventions. Progression of low-grade slips to high-grade slips (>50% translation) is very rare, and almost unheard of in the older adolescent or skeletally mature patient. High-grade slips, while more likely to be symptomatic, still frequently respond to conservative measures such as physical therapy and brace treatment. The patients most at risk for progression of their slip and failure conservative measures include the younger, actively growing patient, especially those with a dysplastic slip. Initial treatment of symptomatic spondylolisthesis should include activity restriction and physical therapy. The use of brace treatment is more controversial as there are no controlled studies proving its benefit over therapy alone, but it still represents a common component of treatment for many practitioners. At the end of the chapter the authors delineate their own treatment regimen.