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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.

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



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.


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.


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.


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%).


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.


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


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