In most cases of spondylolisthesis, non-surgical treatments are tried for several months. If non-surgical treatments do not relieve your pain, you may be recommended surgery. Surgery is a very serious decision to make, so you should feel as informed as possible.
Your spine surgeon will decide which procedure is best for you and how the surgery will be performed. Ask as many questions as you want about the procedure: what will happen before, during, and after the surgery; how long the recovery will take; what instruments the surgeon will use. You should know as much as you can about the surgery before heading to the operating room—that’s part of being an informed patient.
There are usually three surgical procedures for spondylolisthesis:
- Anterior lumbar interbody fusion
- Posterior lumbar interbody fusion
- Transforaminal lumbar interbody fusion
ALIF, PLIF, and TLIF all have the same surgical goals:
- Remove pressure on your spinal nerves (decompression)
- Fix the alignment of the spine
- Stabilize the spine
Often, it is possible to realign the spine (if the surgeon feels this is necessary); however, as long as pressure is taken off the nerves and the spine is stabilized, the surgery is considered a success.
Removing a disc and/or other spinal structure may make your spine unstable. If the surgeon were to leave that “gap” in your spine, your vertebral column couldn’t function properly. It wouldn’t be able to support weight or cushion movements as well. To address this, surgeons will stabilize the spine using a fusion. Either from the front (anterior), back (posterior), or side (transforaminal), the surgeon will fill the gap with a bone graft. This can be bone taken from your own body (autograft) or from a donor’s body (allograft). There are also synthetic substances that will promote bone growth.
Over time, the bone graft will fuse the vertebrae together. To support the spine as the fusion heals, the surgeon will use spinal hardware such as screws, rods, and cages.