Conservative Treatment

Most patients without neurological symptoms or signs should initially be managed conservatively. However, studies have shown that up to one-third of patients with isthmic or degenerative spondylolisthesis are at risk for progressive listhesis, which may lead to neurological deficiencies. Unfortunately, this high-risk population has been difficult to define. Factors reported to be associated with progressive slippage include skeletal immaturity, female sex, dysplasia of the posterior elements, spina bifida occulta, increased slip at diagnosis, a high sagittal rotation angle, and rounding of the superior aspect of the sacrum. Individually, though, none of these factors has been shown to have a consistent effect on slip progression. Still, patients with a combination of these risk factors should be considered for early surgery.

Both flexion exercises and braces designed to reduce lumbar lordosis have demonstrated some efficacy in symptomatic patients with Meyerding grade I or II spondylolisthesis. Other nonoperative techniques such as bedrest, restriction of sports activities, anti-inflammatory analgesics, or injection of the disc space or facet joints with steroids or topical anaesthetics may be of diagnostic assistance, but are of uncertain long-term therapeutic benefit