What is the best way to treat L4-L5 spondylolisthesis?

L4-L5 spondylolisthesis is a spine condition located in the last two vertebrae in the lumbar (lower) spine, labeled L4 and L5. Spondylolisthesis occurs when one vertebra slips out of alignment such that it slightly overhangs the vertebra immediately beneath it. Usually caused by overuse, trauma or age-related spinal degeneration, spondylolisthesis can affect any part of the spine. Often, the condition develops in the lower back (lumbar spine), mainly because this weight-bearing region sustains a significant amount of wear and tear through constant bending, twisting and other daily movements.

If you were recently diagnosed with L4-L5 spondylolisthesis and are now thinking about treatment, you might be feeling a bit overwhelmed, and that’s quite understandable. You may have several possibilities to consider, as well as many questions. And, if your L4-L5 pain symptoms are interfering with your ability to focus on your job, take care of your household responsibilities or spend time with your family and friends, you certainly won’t want to waste valuable time on remedies that ultimately won’t work well for you. Instead, you’d probably prefer to cut to the chase.

So, what is the best approach for treating L4-L5 spondylolisthesis? Before exploring your treatment options, you may find it helpful to briefly consider the goals of spondylolisthesis treatment as well as the specific symptoms that this condition can produce.

What are the most common L4-L5 pain symptoms?

Spondylolisthesis does not always cause symptoms. In fact, some people who have the condition remain completely unaware of it. When discomfort does occur, it is often very similar to that produced by other spine conditions, such as spinal stenosis. More specifically, consider that spinal stenosis causes the open spaces within the spinal column to become narrower due to the presence of displaced tissue, such as a bulging disc, inflamed facet joint, spinal bone spur or thickened ligament. As a result of the narrowing, the spinal cord or a spinal nerve root can become painfully constricted. Likewise, a vertebra that has slipped out of place due to spondylolisthesis can potentially pressure a spinal nerve as well.
Regardless of the source of the pressure, a compressed spinal nerve can produce a number of uncomfortable symptoms. For instance, the main symptoms of L4-L5 spondylolisthesis that causes nerve compression include:

  • Low back pain that worsens with extension (arching the spine backward)
  • Leg pain, numbness and tingling sensations, which may extend down to the feet
  • Leg muscle weakness that intensifies with prolonged standing or walking and improves with sitting and resting
  • Hamstring muscle tightness and spasms (at the back of the thighs)
  • Loss of flexibility in the lower back

The main goal of spondylolisthesis treatment is to address these symptoms in order to ultimately reduce pain and improve function. In many cases, this can be accomplished without surgery.

Nonsurgical treatment is often effective for lumbar spondylolisthesis

The best approach to nonsurgical treatment for spondylolisthesis can vary considerably from one person to the next. However, one common thread is that many people benefit from using a combination of conservative (nonsurgical) therapies. Finding the right combination for you will probably take a bit of trial and error, but a physician can guide your efforts, increase your efficiency and provide individualized advice along the way. Try not to become discouraged. Remember: All of your hard work will be well worth it if you ultimately find effective relief from your L4-L5 pain symptoms. It may even help you avoid an unnecessary surgical procedure.

To begin your spondylolisthesis treatment, your physician will likely advise you to try some of the following types of nonsurgical treatment for L4-L5 spondylolisthesis:

  • Activity modifications. While a brief period of rest (no more than two days) might feel good at first, you shouldn’t linger in bed any longer. Prolonged inactivity can allow the muscles that support your spine to weaken and actually do more harm than good. Instead, try to stay reasonably active while avoiding any body positions and movements that can worsen your pain, such as bending, twisting and lifting, as well as standing and walking for extended periods of time.
  • Physical therapy. Stabilization exercises are the cornerstone of any treatment plan for low back pain, including L4-L5 pain symptoms. Your physician can recommend specific exercises to strengthen your core, abdominal and back muscles, which provide essential support and stability to your spine and can shift painful pressure away from a compressed spinal nerve.
  • Weight management. Carrying excess body weight — even just a few pounds — can significantly increase the stress exerted on your spine with every step you take. Therefore, your physician will probably encourage you to lose weight if you need to, and to maintain a healthy body weight going forward.
  • Hot and cold therapy. Applying a heating pad is a simple but effective way to relax tight muscles around the injured area of your back and also increase your blood circulation, which can promote healing by delivering essential nutrients to damaged tissues. Alternatively, applying an ice pack to a painful area can immediately reduce swelling, numb pain and improve your comfort.
  • Medications. An over-the-counter pain reliever, such as acetaminophen, or a nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen or naproxen, can help you feel better by reducing your spinal irritation and swelling. If you need further relief, your physician may prescribe a stronger medication or recommend an epidural steroid injection, which can provide lasting relief by placing cortisone — a powerful anti-inflammatory medication — directly into the painful area of your spine.
  • A back brace. To help keep your spine in proper alignment as you move about throughout the day, your physician might suggest that you wear a prefabricated or customized brace or corset for a specified period of time.
  • Chiropractic care. While a chiropractor cannot reduce the amount of vertebral slippage in your spine, he or she can manipulate the spinal joints located immediately above and below the slipped vertebra. By addressing the mechanical and neurological causes of your pain, a chiropractor may be able to improve your spinal mechanics, posture and function.

Throughout your treatment journey, your physician will continue to monitor your condition. In addition to checking your symptoms, he or she will periodically evaluate the degree of vertebral slippage in your spine to determine whether it is improving, has stabilized or is progressing.

When to consider lower back surgery for L4-L5 spondylolisthesis treatment

Much like any other type of elective surgery, surgery for spondylolisthesis L4-L5 is a big step, and it is not appropriate for everyone. However, at the end of the day, the best spondylolisthesis treatment plan is one that works — whatever that looks like for you. Most likely, it will be a combination of several conservative treatments, but it may ultimately include surgery if you so choose.

Much like the goal of conservative spondylolisthesis treatment, the goal of surgical spondylolisthesis treatment is to relieve painful symptoms. However, surgery has an additional goal: to address the source of the pain by stabilizing the area of the spine where the damaged vertebra has slipped out of position. In general, surgical treatment for L4-L5 spondylolisthesis is reserved as a last resort for individuals who continue to experience debilitating pain after several weeks or months of conservative treatment. If you’re unable to walk or your L4-L5 pain symptoms are otherwise diminishing your quality of life, your physician may recommend surgery for L4-L5 spondylolisthesis, or you might want to ask about it yourself.

To determine if you are a surgical candidate, your physician will review a number of individual factors, including your:

  • General health
  • Symptoms
  • Amount of excess spinal movement, if any
  • Amount of vertebral slippage and whether it is increasing
  • Other spine conditions
  • Prior spine surgeries, if any
  • Lifestyle and activity level
  • Personal preferences

To help you make fully informed treatment choices, your physician can refer you to a trusted orthopedic spine surgeon or neurosurgeon who can explain the risks and benefits of surgery, answer your questions and otherwise educate you about the procedure that is recommended for you. In order to feel confident in your decisions, it will be important for you to understand the reasoning behind the surgeon’s recommendations. You may also want to seek a second opinion (and a good surgeon will likely encourage you to do so).

Is minimally invasive surgery a treatment option for L4-L5 spondylolisthesis?

Before you make any final decisions regarding surgery for L4-L5 spondylolisthesis, be sure to explore all of your options. For instance, even if surgery is appropriate for you and you want to proceed, you may not be limited to a highly invasive open spine procedure, such as a traditional decompression procedure or spinal fusion. At Laser Spine Institute — the leader in minimally invasive spine surgery — our surgeons perform minimally invasive spine surgery as a safer and effective alternative to traditional open back surgery for treating lumbar spondylolisthesis.^

If you’re interested in learning more, the team at Laser Spine Institute can provide a free MRI review* to help you determine if you’re a candidate for our minimally invasive lower back surgery. Our procedures, which are performed on an outpatient basis, have helped thousands of patients get back to their daily lives. For more information about our minimally invasive surgical approach to spondylolisthesis treatment, contact Laser Spine Institute today.