Conservative treatment with spontaneous stabilization of Grade II isthmic spondylolisthesis L5/S1 in a forty-four-year old woman, with a six-year follow-up A case report

Spondylolisthesis is a pathological condition caused by the slipping of a vertebral body, compared to the underlying structure, following structural and/or degenerative changes to the spine. Studies have attempted evidence to the connection between the natural history of spondylolisthesis, the degree and progression of the slip factor, as well as the pain and disability. Studies have reported a high level of heterogeneity of these factors in different patients as well as difficulty in predicting behaviour. It has been suggested that vertebral instability, independent of the slip factor, could be considered the most important factor to be treated conservatively or surgically. Furthermore, it appears that some patients may manifest complete disk degeneration over time, with vertebral bodies shifting closer and spontaneous stabilisation. This case study reports a forty-four-year old woman, with isthmic spondylolisthesis, where the spine surgeon recommended physiotherapy for conservative treatment, with a prognosis of possible spontaneous stabilization. The case was followed for six years, both clinically and radiologically. Treatment was based on a specific stabilising training program (motor control), immediately aimed to improve the disability and pain factors while waiting for a possible spontaneous stabilisation, that the latest radiological exams revealed with an attempt of arthrodesis. The Oswestry Disability Index (ODI) and the Roland Morris Disability Questionnaire (RMDQ) to measure disability, and the Numeric Rating Scale (NRS) to measure pain, were carried out at the beginning, during and at the end of treatment. They were compared with the radiographic material documenting the evolution of the spondylolisthesis over time. This case study appears to confirm that the hypothesis that a specific aimed approach of rehabilitation may improve the disability and pain levels without compromising the process of spontaneous arthrodesis. The evolution was documented radiographically and clinically over a six-year period.