Spinal Spondylolisthesis: When Conservative Treatments Fall Short, Surgery Offers Lasting Relief

Spinal spondylolisthesis is a condition that can significantly impair quality of life, especially when non-surgical treatments fail to bring lasting relief. This case study explores the journey of a 60-year-old female patient who had been suffering from chronic lower back pain and radiating leg discomfort for over a year. Despite trying various conservative therapies—such as bed rest, oral medications, and traditional Chinese medicine—her symptoms continued to worsen, severely limiting her mobility and daily function. After thorough evaluation and imaging, she was diagnosed with L4 spondylolisthesis accompanied by spinal stenosis at the L4-L5 level. Ultimately, surgical intervention provided dramatic improvement, restoring her ability to walk pain-free and resume normal activities.

Patient Overview & Diagnosis

Patient Profile: Female, 60 years old, overweightDiagnosis: Degenerative lumbar spondylolisthesis (L4 forward slip, Grade I)Hospital: Shanghai Changzheng HospitalDate of Treatment: November 2020Treatment Plan: Reduction, decompression, interbody fusion, and internal fixation surgery at L4-L5Treatment Duration: 7-day hospitalization followed by 2 months of outpatient follow-upOutcome: Significant reduction in back and leg pain, full restoration of walking ability, improved overall well-being

Initial Consultation: Recognizing the Signs

The patient first visited our clinic in November 2020, reporting more than 12 months of progressive lower back pain that had begun as mild discomfort but evolved into severe bilateral leg numbness and shooting pain. The sensation radiated from her buttocks down the posterior thighs and calves, extending to the tops of her feet and big toes—a classic sign of nerve root compression. Her walking capacity was severely limited; she could only walk about 100 meters before needing to stop and squat to relieve the intense tingling and weakness.

She had previously sought care at a local hospital where imaging revealed degenerative changes in the lumbar spine and an anterior slippage of the L4 vertebra. Diagnosed with Grade I spondylolisthesis, she underwent conservative management including prolonged bed rest, NSAIDs, muscle relaxants, and acupuncture-based physical therapy. While there was slight initial improvement, her symptoms returned quickly upon resuming daily activities and progressively intensified, prompting her to seek advanced treatment options.

Diagnostic Imaging Confirms the Problem

To assess the extent of neural compression and structural instability, we ordered a lumbar MRI. Results confirmed moderate disc degeneration, a Grade I anterolisthesis of L4 over L5, and significant narrowing of the spinal canal at that level—resulting in compression of the dural sac. These findings aligned with clinical signs of radiculopathy and neurogenic claudication. Based on this comprehensive assessment, we confirmed the diagnosis: symptomatic L4 spondylolisthesis due to degenerative spinal instability.

Surgical Intervention: A Path to Recovery

Given the failure of conservative treatments and the clear anatomical cause of her pain, we recommended surgical correction. The chosen procedure—reduction, decompression, posterolateral interbody fusion, and pedicle screw fixation at L4-L5—was designed to achieve several critical goals:

Relieve pressure on compressed nerves
Restore proper alignment of the slipped vertebra
Stabilize the affected segment to prevent future slippage
Enable long-term pain relief and functional recovery

The patient and her family were fully informed about the risks, benefits, and expected recovery timeline. After completing preoperative evaluations—including blood work, ECG, and anesthesia clearance—the surgery was performed successfully under general anesthesia. Intraoperative monitoring ensured nerve safety throughout the procedure.

Postoperative Progress and Healing Milestones

Recovery began immediately after surgery:

Day 1: Immediate Symptom Relief

On the same day as surgery, the patient reported a noticeable decrease in leg heaviness and numbness. By the next morning, postoperative X-rays showed excellent placement of the instrumentation and successful realignment of the L4 vertebra. She remained comfortable in bed with minimal pain, managed effectively with short-term analgesics.

Day 3: Early Mobilization

With support from a lumbar brace, she stood and took her first steps with assistance. She was able to use the restroom independently and expressed surprise at how much better her legs felt. Except for mild surgical site tenderness, her previous symptoms of radiating pain and tingling had largely disappeared.

Day 7: Discharge and Home Recovery

After seven days of monitored recovery, she was discharged in stable condition. Wound healing was progressing well, and she received detailed instructions on wound care, activity restrictions, and follow-up appointments.

Two Weeks Post-Surgery: Suture Removal

At her 12-day checkup, incision sites were clean and fully healed, allowing for safe suture removal. No signs of infection or complications were observed.

Two-Month Follow-Up: Full Functional Restoration

During her two-month review, the patient walked into the clinic unassisted, reporting complete resolution of all preoperative symptoms. She could now walk for extended periods without discomfort and had resumed light household tasks. Imaging confirmed solid fusion progress and maintained spinal alignment. Her quality of life had dramatically improved.

Key Recovery Tips for Spondylolisthesis Patients

While outcomes are often excellent, it's important for patients to understand what to expect during recovery:

Temporary Discomfort Is Normal: Some degree of back stiffness, soreness, or mild leg tingling may occur within the first month. This is typically due to residual inflammation or minor nerve swelling and resolves with time.
Avoid High-Risk Movements: Patients should avoid prolonged sitting, heavy lifting, twisting motions, and forward bending for at least 8–12 weeks to protect the healing spine.
Begin Gentle Exercises Early: Under medical guidance, early mobilization and core-strengthening exercises (like ankle pumps and gentle gluteal contractions) help prevent blood clots and speed up rehabilitation.
Nutrition Supports Healing: A balanced diet rich in protein, calcium, vitamin D, and antioxidants promotes bone fusion and tissue repair. Avoid blood-thinning herbs or supplements unless approved by your doctor.
Maintain a Healthy Weight: Excess body weight increases mechanical stress on the lumbar spine, raising the risk of complications or adjacent segment disease later on.

Clinical Insights: When to Consider Surgery

Spondylolisthesis is commonly linked to age-related spinal degeneration, obesity, and sedentary lifestyles. Trauma or congenital defects can also contribute. Early stages often present with nonspecific low back pain, but as the vertebra slips further and narrows the spinal canal, patients develop neurological symptoms like leg numbness, weakness, and difficulty walking.

Many individuals respond well to conservative care, including physical therapy, anti-inflammatory drugs, epidural steroid injections, and lifestyle modifications. However, when symptoms persist despite these efforts, worsen over time, or begin to interfere significantly with daily living, surgery becomes a viable and often necessary option.

In cases like this one, timely surgical intervention not only alleviates pain but also prevents irreversible nerve damage and restores independence. Modern spinal techniques offer high success rates, predictable outcomes, and faster recoveries—making them a valuable solution for appropriately selected patients.