Degenerative spondylolisthesis (DS) describes the degenerative displacement of a vertebra over its subjacent vertebra [1]. Typically, DS occurs on the spinal level ranging from L4 to L5 [1]. Demographically, individuals older than 50 and men are more likely to suffer from DS than their younger or female counterparts [1]. Because of degenerative spondylolisthesis, individuals may develop radiculopathy, chronic low back pain, or neurogenic claudication [1]. Treating degenerative spondylolisthesis, such as with exercise therapy, is crucial to ensuring that patients affected by the condition enjoy a high quality of life.
During the early stages of degenerative spondylolisthesis, physicians prefer to tackle the condition using relatively conservative methods [1]. However, once nonsurgical options have proven refractory for a minimum of three to six months, physicians tend to turn towards surgical treatment [1]. While surgery tends to have high success rates, it can also result in troubling secondary complications, including sagittal imbalance, reduced vertebral mobility, and heightened adjacent segment stress [2]. Understandably, patients and physicians prefer to avoid surgical treatments as much as possible, which renders exercise therapy an attractive alternative option for degenerative spondylolisthesis.
Segmental instability is a primary element of spondylolisthesis [2]. Accordingly, researchers hypothesized that segmental stabilization could benefit DS patients [2]. Choopani et al. studied the effects of segmental stabilization exercises on spondylolisthesis patients [2]. Half of the patients engaged in segmental stabilization exercises, while the other half completed general exercises, consisting of stretching, flexion, and strength exercises [2]. Ultimately, segmental stabilization and general exercise had comparable positive effects on patients’ pain and disability levels [2]. One caveat of the study was that its focus was not solely on DS patients [2]. Nevertheless, the similar etiologies of the various forms of spondylolisthesis diseases suggest that this study can still help guide DS treatments.
Researchers have also studied lumbar exercises in the context of spondylolisthesis with varying results. Khan et al. compared two groups of patients: one engaging in routine physical therapy, including strengthening and lumbar stretching exercises, while the other did so as well, but also regularly engaged in lumbar mobilization [3]. The experimenters concluded that patients suffering from grade I spondylolisthesis exhibited better functional and pain outcomes when also engaging in lumbar mobilization [3].
Additionally, Nava-Bringas and colleagues tested the benefits of lumbar stabilization in the context of degenerative spondylolisthesis [1]. They compared lumbar stabilization to flexion exercises but did not identify notable differences between the two exercises in terms of pain relief or disability levels [1]. Regardless, both therapies appeared beneficial, and their comparable effects suggest that physical therapists have multiple options when treating DS patients [1].
The effects of exercise in combination with surgery to improve DS patients’ quality of life have also been the subject of multiple experiments [4, 5]. One study compared the effects of 12-month exercise therapy to a usual care regimen on spondylolisthesis patients who had recently undergone lumbar spine fusions [4]. Unfortunately, neither group was preferable in terms of increasing physical activity or decreasing kinesiophobia [4]. A similar study found that post-operative exercise interventions did not appear to relieve patients’ level of disability or improve their quality of life beyond the improvements already produced by usual care [5]. Alternative post-surgical regimens may be preferable.
While exercise therapy can be beneficial to many patients suffering from degenerative spondylolisthesis, a single superior exercise regimen has not yet been found. In the future, researchers may wish to investigate the benefits of hybrid treatments, such as psychological rehabilitation, that seem promising [6]. Degenerative spondylolisthesis is a difficult disease to manage, but the variety of treatment options available to healthcare teams is reassuring.
References
[1] T. I. Nava-Bringas et al., “Stabilization Exercises Versus Flexion Exercises in Degenerative Spondylolisthesis: A Randomized Controlled Trial,” Physical Therapy, vol. 101, no. 8, p. 410-417, August 2021. [Online]. Available: https://doi.org/10.1093/ptj/pzab108.
[2] R. Choopani et al., “The effect of segmental stabilization exercises on pain, disability and static postural stability in patients with spondylolisthesis: A double blinded pilot randomized controlled trial,” Muscles, Ligaments, and Tendons Journal, vol. 9, no. 4, p. 615-626, February 2020. [Online]. Available: https://doi.org/10.32098/mltj.04.2019.18.
[3] U. Khan et al., “Effects of routine physical therapy with and without lumbar mobilization in patients with grade I spondylolisthesis,” Rawal Medical Journal, vol. 46, no. 1, p. 91-93, January-March 2021. [Online]. Available: https://www.rmj.org.pk/fulltext/27-1601911137.pdf.
[4] O. Ilves et al., “Effectiveness of Postoperative Home-Exercise Compared with Usual Care on Kinesiophobia and Physical Activity in Spondylolisthesis: A Randomized Controlled Trial,” Journal of Rehabilitation Medicine, vol. 49, no. 9, p. 751-757, July 2017. [Online]. Available: https://doi.org/10.2340/16501977-2268.
[5] O. Ilves et al., “Quality of life and disability: can they be improved by active postoperative rehabilitation after spinal fusion surgery in patients with spondylolisthesis? A randomised controlled trial with 12-month follow-up,” European Spine Journal, vol. 26, no. 3, p. 777-784, September 2016. [Online]. Available: https://doi.org/10.1007/s00586-016-4789-5.
[6] M. Monticone et al., “Management of catastrophising and kinesiophobia improves rehabilitation after fusion for lumbar spondylolisthesis and stenosis. A randomised controlled trial,” European Spine Journal, vol. 23, no. 1, p. 87-95, January 2014. [Online]. Available: https://doi.org/10.1007/s00586-013-2889-z.