This document discusses treatment options for spondylolisthesis, including conservative and surgical approaches. For conservative care, it recommends flexion-based exercises that target trunk stability muscles over extension-based programs. A specific study found exercises training deep core muscles provided better pain relief than usual care. Surgical fixation with decompression may be needed for high grade or unstable cases. Postoperative rehabilitation involves three phases focusing first on self-care, then adding strengthening and mobility exercises before progressing to resistance training.

1. Treatment of
Spondylolisthesis
Heba El Saeid

2. Conservative Treatment

3. Flexion Vs. extension based
program
Exercises focused upon stability of the trunk
should be implemented when seeking to treat
spondylolisthesis through conservative modalities.
Flexion-based PT exercise regimens appear to be
superior to extension-based programs in achieving
symptomatic relief. Flexion exercises have been
shown to yield favorable results in the few
randomized studies published.

4. Specific exercises Vs. Commonly
prescribed programs
Evaluation of Specific Stabilizing Exercise in the
Treatment of Chronic Low Back Pain With
Radiologic Diagnosis of Spondylolysis or
Spondylolisthesis
From the School of Physiotherapy, Curtin University of
Technology, Western Australia.
A randomized, controlled trial, test-retest design, and 30-
month postal questionnaire follow-up.

5. Forty-four patients with this condition were
assigned randomly to two treatment groups. The
first group underwent a 10-week specific exercise
treatment program involving the specific training of
the deep abdominal muscles, with co-activation of
the lumbar multifidus proximal to the pars defects.
The activation of these muscles was incorporated
into previously aggravating static postures and
functional tasks. The control group underwent
treatment as directed by their treating practitioner.

6. After intervention, the specific exercise
group showed a statistically significant reduction in
pain intensity and functional disability levels, which
was maintained at a 30-month follow-up. The
control group showed no significant change in
these parameters after intervention or at follow-up.

7. Four key variables as predictors
of successful treatment
1. Age less than 40 years old (3.7 higher
odds of success)
2. Average straight leg raise at baseline
3. The presence of aberrant movement
during lumbar range of motion
4. Positive prone instability test.

9. Bracing
• Patient that underwent 2 to 4 weeks rest and
still symptomatic ( UW )
• Boston brace showed great results with grade !
Spondylolisthesis
• Bracing can be done in flexion to prevent
hyperextension of the lumber region or even in
extension and both showed good results in low
grade spondylolisthesis

10. Surgical Management
• Surgical Fixation with Decompression with
or without fusion
• Evidence of the significance of reduction is
not sufficient
• High grade spondylolisthesis with unstable
pelvis is indicated for surgery in pediatric
even if Asymptomatic but less likely
indicated in Adults

12. Postoperative Rehabilitation
Phase I:
• 1 to 5 days after surgery (inpatient) and up
to 6 Weeks
• Physical therapy management during this
phase consists of teaching patients the
proper way to get in and out of bed, dress
and perform other self-care activities, and
walk (perhaps with a walker for the first 1
or 2 days).

13. • Light TA and pelvic floor contractions to
begin to practice them in different
positions.
• The therapist also can teach basic and
simple neural mobilization for the nerves
involving the lumbosacral plexus.

14. Phase II:
• 6 to 10 weeks after surgery
• Patients should begin to approximate normal
activities while the therapist controls
• patients should be slowly working up to 30 minutes
of exercise and physical activity at least 5 days a
week. They can begin a light weight-training
program, avoiding exercises that inappropriately
load the lumbar spine but making sure to include
some exercise for the lumbar paraspinals and other
muscles that attach to the thoracodorsal fascia.

15. Goals:
• Achieve good body mechanics during ADL
• Protect the surgical site from infection and
mechanical stress
• nerve root mobility at the involved levels
Body mechanics education:
• bed mobility:
• pushing and pulling
• Lifting and carrying
• Hip hinge technique

17. Strengthening Exercises
• Training of the TA, multifidus, and pelvic floor
muscles with and without using pressure
biofeedback (BFB)
• Abdominal breathing
General conditioning exercises
• Wall squats and sit to stand
• Half lunges
• Step ups and step downs
• Walking

18. • Hip flexors stretching should only start after
the permission of the surgeon. stretching
should be very gentle and only pushed to the
point the patient can brace to prevent lumbar
motion.
• one of the most stressful motions in the
lumbar spine is rotation, which causes a
shearing effect across the disc. Since
the thoracic spine is designed to allow more
rotation, limited motion here may increase
strain on the lumbar spine during twisting
motions. The PT can use manual mobilization
techniques to increase thoracic spine mobility

19. Phase III:
• initiate resistance training program
• They often return to work with modified duties or on a
part-time schedule.
• patient should be independent with self-care duties
and also with a moderately challenging home
exercise program.
• More strenuous stabilization activities, such as half
and full front and side planks could be added.

20. • The previous trunk stabilization activities should be
progressed within the patient tolerance with
modifications according to the patient's condition.
• It is not advised to do complex weight lifting tasks,
but to focus on light free weight activity and machine
based exercises that allow the patient to perform
them with proper posture, technique, and bracing.
• Patients should be extremely careful with
overhead lifting because of the axial load and
compressive forces placed on the spine.