Non-Fusion Surgery For Degenerative Spondylolisthesis of The Lumbar Spine

The natural aging process has a noticeable impact on the entire body. The spine is included in this process and, as a result, degenerates with age. 

Several different spinal conditions can develop as a result of age-related degeneration. Spondylolisthesis is one such condition. It occurs when one of the spinal bones, or vertebrae, slips out of position due to instability. The vertebra then settles on the bone beneath it. 

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Degenerative spondylolisthesis can be a debilitating condition. The misaligned vertebra may press on the spinal cord, along with the spinal nerves. This can cause persistent back pain and neurological symptoms like weakness, tingling, and numbness. 

Spondylolisthesis typically doesn’t require surgery. When it does, spinal fusion is the most long-standing procedure to correct the instability. However, thanks to recent innovations in the field of medicine, patients who must undergo spondylolisthesis surgery can now consider non-fusion surgery to preserve their mobility. 

In this article, we’ll explore the topic of non-fusion surgery for degenerative spondylolisthesis and how it may benefit patients suffering from this condition. 

When is The Time to Have Surgery For Spondylolisthesis?

Generally, spine specialists have patients undergo non-surgical spondylolisthesis treatments for six to 12 months before even contemplating surgery. Non-surgical therapies for this condition include:

  • Physical therapy, which generally focuses on targeted exercises and passive therapies to increase mobility and muscle strength
  • Chiropractic care, which focuses on restoring the alignment of the spine
  • Medications for pain and inflammation, which may be obtained either with a prescription or over-the-counter
  • Epidural steroid injections, which can rapidly alleviate pain and inflammation, but shouldn’t be used for than three to four times per year
  • Lifestyle modifications, which may involve a targeted exercise plan, avoiding specific activities, quitting smoking, etc.

If these methods fail to provide any improvement after several months, surgery may be the next logical step in treatment planning. However, in certain scenarios, your physician may recommend surgery sooner.

For example, if a patient experiences pain from spondylolisthesis that’s debilitating enough to disrupt their capacity to walk, sleep, and carry out other essential day-to-day tasks, surgery may be necessary. Additionally, if spondylolisthesis causes severe nerve compression, surgery may be essential to prevent permanent neurological damage. 

Am I a Candidate For Spondylolisthesis Surgery?

Not all patients are good candidates for spondylolisthesis surgery. Though opting for a minimally invasive, non-fusion procedure lowers the overall probability of complications, smoking and being overweight can both put you at risk. 

Spinal surgeons may instruct their patients to lose weight and/or quit smoking (or using any product that contains nicotine) before undergoing spondylolisthesis surgery. Making these adjustments will increase your odds of making a full, successful recovery. 

Is Spinal Fusion Always Necessary For Spondylolisthesis?

To explain whether or not fusion is always required for spondylolisthesis, let’s first consider a brief overview of the grading system for this condition:

  • Grade 1 spondylolisthesis: 25% of the vertebra has shifted forward 
  • Grade 2 spondylolisthesis: 50% of the vertebra has shifted forward
  • Grade 3 spondylolisthesis: 75% of the vertebra has shifted forward
  • Grade 4 spondylolisthesis: 100% of the vertebra has shifted forward
  • Grade 5 spondylolisthesis: The vertebra has fully fallen off of the next vertebra (also known as spondyloptosis

Patients who have been diagnosed with grade 3 or 4 spondylolisthesis and don’t improve after six months of non-surgical treatment may need surgery to recover. In the past, spinal fusion was the only option to correct the instability that caused vertebral slippage. 

Additionally, degenerative spondylolisthesis patients who develop certain neurological issues may need emergency medical attention. These problems include progressive numbness or weakness in the legs, as well as a new loss of bladder or bowel control. Although these symptoms are rare, they can indicate a risk of permanent nerve damage.  

In most cases, the choice to undergo spinal fusion for spondylolisthesis is a personal decision that’s completely up to the patient. 

An Overview of Spinal Fusion

As the name implies, spinal fusion surgery involves permanently fusing two or more vertebrae. The goal of this procedure is to stabilize the spine, often after spinal decompression surgery. Given that spondylolisthesis is triggered by instability, fusion is widely used for spondylolisthesis. 

While spinal fusion can successfully resolve instability, it permanently eradicates all movement at the affected segment. So, patients lose mobility in the fused area of the spine. They may lose the ability to bend, twist, flex, and partake in a range of activities. 

Additionally, because it involves the healing of bone tissue, spinal fusion requires a lengthy recovery process. It may take up to a year to make a full recovery from this surgical procedure. 

What is a Non-Fusion Spinal Surgery?

Medical innovations have created a new treatment option for patients struggling with degenerative lumbar spondylolisthesis: non-fusion spine surgery. This procedure generally involves the use of a non-fusion implant to stabilize the affected spinal segment without fusing the vertebrae. 

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Non-fusion implants and artificial disc replacement surgery can provide the following benefits over conventional fusion:

  • Preserve the motion of the spine so that patients can return to their usual activities while experiencing relief from back pain and neurological symptoms
  • Reduce the risk of degeneration in the adjacent spinal segments, which is a relatively common complication of spinal fusion
  • Lower the risk of revision surgery
  • Shorten the spinal surgery recovery process

The TOPS System is one implant option for non-fusion lumbar surgery. Designed to be used in the L3 to L5 vertebrae, it works by creating a controlled range of motion in the affected vertebrae. The device provides immediate pain relief and a faster, less painful recovery process when compared to spinal fusion. 

Non-fusion spinal decompression surgery is an emerging treatment option for patients with degenerative spondylolisthesis. Talk to your physician today to learn more about this type of procedure and whether or not it could help you overcome debilitating symptoms.