With a degenerative spondylolisthesis, one bony vertebra slips ahead of the one below it and along with the slippage a nerve root may become pinched. This may end up with sciatica on a repetitive process and can be very painful and problematic for individuals on an ongoing 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 spinal fusion may dramatically help with the symptoms if conservative measures fail. Nonsurgical methods include az pain management treatments such as interventional pain management (e.g. epidural injections), narcotic pain medications, Phoenix physical therapy, spinal decompression treatment, and chiropractor.

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 called a laminectomy and effectively decompresses the areas experiencing pinched nerves. The pre-operative MRI tells the surgeon which areas are being pinched and where to focus his or her efforts. There can be some further surgical findings, but adopting an approach of "let's see what's happening when I"m in there" is suboptimal.

The bone removed is saved and ground up and typically an additional biologic substance is supplemented to this material. 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. The metallic hardware keeps the bones situated in place until the bones weld together. 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.

Whether or not to undergo spine surgery for isthmic spondylolisthesis is a very good question. When a patient has a stress fracture in the spine (spondylolysis) which is bilateral, and then one vertebral body slips on the one below, that is termed isthmic spondylolisthesis. 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 fracture doesn't heal but died out after trying, then what you can end up with is the vertebral body slipping forward as the back part of the spinal level stays put and what you end up with is one vertebral body slipping forward over the one below it, which is called spondylolisthesis.

In order to see whether surgery is indicated for spondylolisthesis, a decision needs to be made as to the slippage degree. A Grade 1 slip means the vertebral body slips between 0 and 25% compared to the vertebral body below it. A Grade Two Slip is defined as a vertebral body slipping forward 25 to 50% of the length is 75 to 100% of one vertebral body over the bottom one. A Grade Five is over 100%, and this is actually called spondyloptosis.

Research studies have shown by the time an individual is seen with spondylolisthesis that is symptomatic, the person's slip has achieved ninety percent of that it will ever slip. Studies of isthmic spondylolisthesis also show that surgery is indicated for slips that are over a Grade Two. 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 could include physical therapy, phoenix chiropractor treatment, spinal bracing, TENS machines, and pain management.