Spondylolisthesis Treatment Options

For patients with mild symptomatic lumbar spondylolisthesis, Dr. Singh initially recommends conservative management including:

• Activity modification including abstaining from sports
• Heat and light exercise
• Anti-inflammatory medications to reduce pain
• Epidural steroid injections
• Physical therapy involves a thorough McKenzie Evaluation (taking a history and performing a physical exam) to determine the mechanical nature of the patient’s pain and to identify specific movements and positions that alleviate or worsen symptoms.

If a patient does not improve after non-surgical treatment and the vertebra continues to slip, Dr. Singh may suggest minimally invasive surgery as a solution for the spondylolisthesis.

Minimally Invasive Laminectomy

In this procedure, Dr. Singh will make a small incision, the size of a nickel, in the back at the level of nerve compression and insert a device called a tubular retractor. This thin tube-shaped tool allows for the creation of a tunnel, gently moving aside muscle and soft tissue, in the affected area of the spine to provide access to the compressed nerves. He can then insert small tools through the tunnel and operate to decompress the affected nerves.

Ultra-Minimally Invasive Endoscopic Laminectomy

In this cutting-edge procedure, a 10 millimeter or smaller skin incision (pen tip sized incision) is made, and the endoscope, a thin flexible tube with a camera and light at the tip is inserted.  Depending on the patient’s condition, the endoscopic technique may access the spine using one of two approaches: either an intralaminar (from the back of the spine between two laminae) or transforaminal (from the back/side of the spine into the neuroforamen; a nerve passageway) approach.

Throughout the procedure, the camera captures and projects real-time images of the operative site onto a monitor for Dr. Singh to see. The endoscopic camera assists and guides Dr. Singh during the surgical procedure. The images and videos of the disc bulge and nerve root are provided to the patient following surgery.

Most patients experience immediate and significant improvement in their pain because the compression of nerves has been corrected immediately following surgery.

Minimally Invasive Lumbar Fusion

If a patient has had repeated lumbar disc herniations or has significant instability and slippage, a minimally invasive lumbar fusion may be performed.

In a minimally invasive fusion, Dr. Singh uses special equipment that allow for a much smaller incision (less than the size of a quarter) without cutting muscles that allow him to perform these procedures as outpatient surgery with patients going home 3-4 hours after the surgery.

A minimally invasive lumbar fusion can be performed from the front (anterior approach), from the back (posterior approach) or from the side (lateral approach). Dr. Singh chooses which approach is the least invasive based upon many factors, including the need for bone spur removal, the degree of instability, the medical condition, and build of the patient. The following are minimally invasive spinal fusion approaches that Dr. Singh performs in a minimally invasive outpatient fashion:

• Anterior Lumbar Interbody Fusion (ALIF) with Instrumentation (from the front)
• Transforaminal Lumbar Interbody Fusion (TLIF) (from the back)
• Lateral Interbody Fusion (XLIF, DLIF, OLIF) (from the side)

Patients can expect the surgery to be performed as an outpatient in the hands of Dr. Singh. Whether the patient undergoes a ultra-minimally invasive endoscopic approach or a minimally invasive fusion you can expect to be walking in a few hours after surgery and discharged home the same day from the surgery center. Patients can expect rapid recovery in a few days with return to work within 24 hours being possible.

Dr. Kern Singh, MD is an internationally renowned spine surgeon specializing in outpatient minimally invasive and motion-preserving techniques and endoscopic spine surgery at Midwest Orthopaedics at Rush and Professor in the Department of Orthopaedic Surgery at Rush University Medical Center in Chicago, Illinois. Dr. Kern is one of the nation’s Top 100 spine surgeons and beloved by his patients for his compassionate care and excellent outcomes. He welcomes nationally and internationally-based patients.