The Fate of Nonoperative Management in Patients with Lytic Spondylolisthesis

Abstract

Introduction: There is a lack of consensus within the current literature about the role of nonoperative management in lytic spondylolisthesis. Our objective was to assess the fate that nonoperative management plays in patients diagnosed with lytic spondylolisthesis. Material and Methods: Data was collected from 41 patients between May 2015 to February 2020 who were initially referred specifically for instrumented lumbar fixation but were instead planned for nonoperative management as they opted to avoid surgery. MRI scans were used to determine spondylolisthesis grade, type of deformity and radiological features. Patient notes were reviewed to establish management plans. Furthermore, patients were also contacted via telephone to assess their symptoms and disease progression. Results: 26 of the 41 patients had lytic spondylolisthesis (63.4%). Of these patients the male to female ratio was 10:16. The median age was 60 (range: 22 to 76). A total of 12 patients were managed nonoperatively for 5 years or longer with 2 patients showing progression from grade I to II. Conclusion: Nonoperative management of lytic spondylolisthesis is a reasonable option in a selected cohort of patients. The longer in duration, patients are managed conservatively the less likely they are to require a surgical intervention. Even severe radiological foraminal stenosis without radicular pain does not seem to push patients towards surgery. Management decisions must be made on an individual basis. This data can give some reassurance to patients that wish to consider nonoperative management and help guide clinicians.

Erector spinae could be the game changer in surgical decision-making in patients with lumbar spondylolisthesis: a cross-sectional analysis of an age-, sex-, subtype-, level-matched patients with similar spinopelvic parameters received surgical or conservative management

“…The correlation of DS progression and intensity of pain is controversial [31]. Sinha and George [42] observed that even severe radiologic foraminal stenosis without radicular pain did not seem to push patients to undergo surgery. A recent meta-analysis depicted that not all patients with DS end up with significant pain/disability and eventually require surgery [31].…”