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J Back Musculoskelet Rehabil. 2019 Jan 11. doi: 10.3233/BMR-181185. [Epub ahead of print]

Comprehensive non-surgical treatment decreased the need for spine surgery in patients with spondylolisthesis: Three-year results.

Author information

1
Department of Orthopaedic Surgery-Spine Center, University of California, San Francisco, CA, USA.
2
Department of Physical Medicine and Rehabilitation, Pain Management, Medical School, Marmara University, Istanbul, Turkey.

Abstract

BACKGROUND:

Non-surgical treatment is the primary approach to degenerative conditions of the lumbar spine and may involve multiple modalities. There is little literature to guide an evidence-based approach to care.

OBJECTIVE:

To determine the effectiveness of CNT (comprehensive non-surgical treatment) in patients with degenerative spondylolisthesis (DS) and spondylolytic spondylolisthesis (SS), and to identify predictor variables for success of CNT in avoiding surgery.

METHODS:

All patients who underwent CNT for spondylolisthesis (n: 203) were included. CNT consisted of patient education, pain control with transforaminal epidural steroid injections (TFEs) and/or medications, and exercise programs.

RESULTS:

Surgical and non-surgical patients were similar in age, smoking status, comorbidity scores, facet joint widening, and translation of spondylolisthesis. After CNT, only 21.6% of patients with DS and 31.3% of patients with SS chose to have surgery in 3-years follow-up. The non-surgical group reported significantly better pain relief (73.6% vs 55%) after TFEs for a longer period (152.8 vs 45.6 days) and lower opioid use than the surgical group (28.2% vs 55.3%).

CONCLUSIONS:

CNT is effective in spondylolisthesis and more successful in DS than SS. CNT may decrease the need for surgery, particularly in patients who report pain relief greater than 70% for average five months after TFEs.

KEYWORDS:

Spondylolisthesis; back pain; epidural; non-surgical treatment; steroids

PMID:
30664502
DOI:
10.3233/BMR-181185

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