Outpatient treatment for Spondylolisthesis

What is Spondylolisthesis?

Bones may sometimes shift in place due to abnormalities in the spinal joints called the facet joints or in the intervertebral discs, and this condition is called "spondylolisthesis". The two types of spondylolisthesis comprise an “anterior slip" where the bone slides forward and a "posterior slip" where the bone slides backward. It is usually said that most spondylolisthesis are caused by anterior slip. Most of spondylolisthesis cases fall either in the category of "lumbar degenerative spondylolisthesis" or "spondylolytic spondylolisthesis". The symptom of low back pain caused by the position of the lumbar spine deviating from its original position is called "lumbar degenerative spondylolisthesis". On the other hand, the strain occasioned by a spine which has shifted from its original position can lead to cracks in the protrusions behind the lumbar spine, and the resulting instability of the entire lumbar spine is called lumbar spondylolytic spondylolisthesis. Although the exact cause is unclear, most patients seem to have practiced a sport in their youth, and as the discs tissues that hold the lumbar spine in place, such as the vertebrae, ligaments, and joints, degenerate with age, the ensuing loss of stability in the lumbar spine is believed to lead to spondylolisthesis.

  • lumbar degenerative spondylolisthesis
  • spondylolytic spondylolisthesis

What are the symptoms of spondylolisthesis?

Symptoms include numbness or pain in the buttocks and thighs after walking only for a short distance. After a short break, the patient is usually able to walk again, but the repeated alternance of walking and resting episodes is a characteristic symptom of spondylolisthesis.
In the case of spondylolisthesis, the nerve canal that run behind the lumbar spine may become misaligned and lead to nerve compression, resulting in symptoms similar to spinal canal stenosis.
Once a lumbar spine is out of alignment, the lumbar vertebra will not return naturally, so once it has slipped, it may prove difficult to restore to normal.

Treatment options for spondylolisthesis

Conservative treatments

Using corsets to make up for the instability of the lumbar spine and painkillers or block injections to deal with the pain might be considered.
Also, there are training methods aimed to strengthen the muscles around the lumbar area, which in turn strengthen the muscles, ligaments and joints that support the hipbone.
Still, conservative treatments do not address the root of the problem and cannot completely eradicate the pain.
Therefore, if conservative treatments do not relieve the pain and numbness, or if the pain is so severe that it prevents the patient from moving normally and impacts daily life, surgery may be considered.

Surgical operation

A "Lumbar spine fusion" is a surgical procedure used when the pain is severe, and the lumbar spine is very unstable. First, the bone is shaved to widen the nerve canals that have been compressed, and then secure the bone openings with bolts. This stabilizes the lumbar bone and reduces the occurrence of pain.
If the instability is not too pronounced, a “lumbar posterior decompression” procedure may be considered to remove pressure on nerves by using an endoscope. Decompression surgery is performed by removing a portion of the vertebral arch, ligaments, and parts of the articular process, thus alleviating pressure on the nerve.
After surgery, the patient must also spend time wearing a corset to immobilize the back.

  • Spinal fusion

  • Posterior lumbar decompression

Risks associated with spondylolisthesis surgery

There is some risk that lumbar fusion and posterior lumbar decompression damage nerves and blood vessels.
There is also a risk that the patient may contract an infectious disease and get suppuration due to bacterial infection in the operated area. With spinal fusion, a shift in the lumbar vertebra may occur due to a damaged fixation device or loosened screws. Alternatively, there is a risk that the patient's allergic predisposition may be overlooked due to lack of prior communication with the doctor, and an allergic reaction due to metal or artificial materials may occur after surgery.
In addition, attaching a fixation device may induce symptoms such as an odd feeling, a sense of weariness, and pain in the lower back that can last for as long as a year for some people.
Since bending and twisting the back may be difficult after fusing the spine, some movements of daily life may become limited in scope.

How is our clinic’s treatment effective for spondylolisthesis?

Lumbar fusion and posterior lumbar decompression may not be an option if surgery poses a high risk to the patient, or for those who already had surgery once but need to be treated again.
At our clinic, we offer DST as a treatment for spondylolisthesis. Elder patients who are at high risk during surgery or those who wish to undergo a second surgery may also benefit from the DST procedure. By repairing and regenerating the degenerated intervertebral disc, it is possible to prevent the progression of spinal misalignment that is the cause of spondylolisthesis.
It can also stabilize an unstable spine, such as one affected by spondylolytic spondylolisthesis, and prevent the onset of pain.

  • A cracked intervertebral disc.

  • The needle is inserted into the cracked disc and the drug is injected.
    *There are very few allergic reactions and side effects caused by the drug.

  • Repair and regenerate the intervertebral disc.

  • Contrast tests show if disc damage exists.

  • A medicine is administered
    into the damaged area of the disc.

  • Allergies and side effects to the medicine are extremely rare.

Treatment flow

  • 01 Consultation with one of our doctors

    An MRI and x-ray will be taken, and the doctor will then make a diagnosis.
    If the diagnosis indicates that DST is suitable, you can start the procedure on the afternoon of the same day.

  • 02 Before the procedur

    A local anesthetic is administered to the lower back in the operating room and a needle is inserted into the lumbar disc(s) identified during the examination.
    An examination using a contrast agent is performed to pinpoint the location of the damaged disc.

  • 03 The procedure

    Fluoroscope guidance is then used to locate the disc and administer the drug to the damaged area. Once the drug has penetrated the zone, the needle is removed, and the bleeding is controlled.

  • 04 Going home

    The patient can go home upon completion of the treatment, after resting in a private room for about an hour and a final routine examination by the doctor.
    *The time of release depends on the patient's symptoms and condition.

Treatment cost of the DST procedure

Locations Treated 1 disc 2 discs 3 discs 4 discs 5 discs
Cost of Treatment 1,320,000 Japanese Yen (JPY) 1,430,000 Japanese Yen (JPY) 1,540,000 Japanese Yen (JPY) 1,650,000 Japanese Yen (JPY) 1,760,000 Japanese Yen (JPY)
*If the procedure is performed in our hospital, all the costs of consultation, diagnosis, MRI and other tests will be included in the costs listed above.
*If the same treatment is performed again within 3 years of the first treatment, the treatment fees will be reduced by half.
*All taxes included.
*Since this method of treatment is not covered by health insurance, the patient must bear the entire cost of the treatment.
*In case of treatment only (one day treatment), We accept payment by credit card (VISA, MasterCard, China UnionPay).
*If you wish to request rehabilitation (specialized for back pain), bank transfer by credit card is also accepted.
*You can receive a tax refund at the time of filing your tax return for medical expenses.

Q&A about Spondylolisthesis

  • question

    Does Spondylolisthesis distort the entire spine?


    Yes, as the Spondylolisthesis progresses, other back conditions may arise.
    Spinal stenosis, which puts pressure on the nerves and narrows the nerve pathways, and disc deformities, may lead to disc heniation.

  • question

    Is spondylolisthesis more likely to occur with a poor posture?


    This can be one of the causes. But it is not the only cause, and you need to ask yourself if you are in an uncomfortable position due to aging or your daily work environment. It is important to be careful not to put unnecessary burden on the back.

  • question

    Are there any movements I should avoid with spondylolisthesis?


    If you suffer from anterior spondylolisthesis, avoid bending your body backwards. Also, if you have posterior spondylolisthesis, you must be careful not to make any movements bending forward.

  • question

    Is there any way to prevent Spondylolisthesis?


    Try to avoid movements that put strain on your back.
    If you have been diagnosed with a condition such as herniated disc(s) or spinal stenosis, you especially should be performing back pain training on a regular basis, and we also recommend walking or other moderate amounts of physical activity.

  • question

    Is there a way to fast track recovery from Spondylolisthesis?


    Recovery is estimated to take between six months to a year, depending on the person. And even if the pain or numbness improves, the time to recovery will usually depend on the original symptoms and general condition.

5 Types of Outpatient Treatment for Low Back Pain

  • The DST Method (Discseel™)

    An intervertebral disc treatment that began in the United States in the 2010s. Can be suitable for a wide range of conditions, including problems in patients after surgery. It is the only (※2)treatment that can repair and regenerate intervertebral discs.
    ※2 According to research by Operation Japan (Ltd.)

    Click here for details.
  • The PIDD Method (Implant)

    An implant intervertebral disc treatment that has been conducted since the 2000s. As with PLDD, results without injury to intervertebral discs can be anticipated. This treatment is suitable for herniated discs only.

    Click here for details.
  • Hybrid Laser Treatment

    A treatment that combines the benefits of PLDD and PODD. This treatment is suitable for herniated discs only.

    Click here for details.
  • The PODD Method (Ozone)

    An ozone intervertebral disc treatment that has been conducted mainly in Europe since the 1990s. It can be suitable for a wide range of conditions.

    Click here for details.
  • The PLDD Method (Laser)

    An outpatient, laser intervertebral disc treatment that has been well known worldwide since the 1980s. This treatment is suitable for herniated discs only.

    Click here for details.