5 Reasons To Consider Spondylolisthesis Surgery

spondylolisthesis surgery

Surgery is a scary word. There is no other way to describe it.

Anytime you have to be put “under” and operated on your mind immediately starts to consider the worst that could happen.

Thoughts can become even more worrisome when we factor in that the spine is involved. Due to the complexity and importance of the spine, many spondylolisthesis patients who come face to face with surgery immediately think about the worst and start to really question if surgery is necessary for them.

Questions such as the following begin to flood the mind:

  • Is surgery safe?
  • How long will I be confined to a bed?
  • How long is the recovery?
  • Is it painful?
  • What if something goes wrong?
  • Will my current pain be eliminated?
  • What are the odds that my pain stays?
  • Am I guaranteed to improve?

These are just a few of the thoughts spondylolisthesis patients are faced with when it comes to surgery.

Unfortunately, I cannot answer these questions and they are best fit for you and your doctor to discuss.

And to be honest, these questions should be brought up to your doctor.

Due to the various types of surgery, your exact condition and injury history, these questions can have a wide range of answers from case to case.

So instead of addressing the questions I cannot answer, let’s address one very important question that I can cover. This question is a very common one that I get from our readers:

When should I consider surgery for my spondylolisthesis?

I have thought about this question for a while and over time I have come up with 5 instances when I think surgery is a legit option for spondylolisthesis patients.

But before we begin, please keep in mind, there is no known 100% accurate “cure” for having a spondylolisthesis or spondylolysis. This is why so many doctors, rehab specialist, chiropractors, etc. take various approaches.

Even with surgery, you are not guaranteed a 100% success rate. I am not trying to deter you from surgery or scare you, I am simply providing you with facts.

I am neither against nor for surgery as a whole. I think certain situations call for certain approaches. Unfortunately, I have worked with and talked to people who have had spondylolisthesis surgery where the outcomes where not what they had hoped for. I have also talked to those who have had surgery and found great relief.

Issues arise when people turn to surgery to quickly in hopes of a quick fix. Instead of eliminating non-surgical options first, they turn to surgery right away.

The point of this entire site and article is to provide you with as much information as possible to help you make the best and most informed decision in your specific situation. Sometimes surgery is necessary and sometimes it can be avoided. The important thing is that you are prepared and knowledgeable to make the best decision for your specific case.

With that being said…. let’s discuss 5 situations where you may want to consider surgery.

1. Your spondylolisthesis is graded as a grade 3 or higher

Do you know what grade your spondylolisthesis is?

If not, I would highly recommend talking to your doctor to find out exactly what grade you have if you are truly considering sugery.

In a nutshell, a spondylolisthesis is when one vertebra slides or slips over another vertebra. Doctor’s often use a grading system called the Meyerding Grading System to determine the severity of the slippage.

This system looks at the amount of slippage by measuring the space between the two vertebrae. Doctor’s then give the spondylolisthesis a grade from 1-4. With grade 1 ranging from 0-25% slippage and grade 4 being 75% slippage or more.

For more information on the grading scale read my post titled Spondylolisthesis Grades HERE.

Once a spondylolisthesis reaches a grade 3 the patient is more likely to experience debilitating pain in the form of nerve pain due to the amount of slippage that is present. Patients suffering from grade 3 spondy’s are also more likely to have bladder or bowel symptoms that are rarely improved through non-operative measures.

If your spondylolisthesis is a grade 3 or 4 and you have found little to know relief through non-operative measures it may be time to consider researching surgery options.

2. You have had multiple failed doctor and therapy visits

One piece of advice that I always recommend to spondylolisthesis patients is to visit multiple doctors and therapist before deciding to go the surgery route.

There are several reasons for this.

Doctors often have vastly different views on how to attack your spondylolisthesis. Some doctors will do anything and everything they can before trying surgery, while other doctors are often quick to recommend surgery. It is a good idea to get a range of views before committing to surgery.

Not all therapy is the same. As I discussed HERE, finding the right therapy for you is often one of the hardest things of the improvement process.

The more individuals you see and hear from, the more information your will learn about you, your body and your condition which will ultimately help you with your decision about surgery.

Personally, I have seen multiple doctors (I estimate over 8) and have visited multiple therapist. Many of which did no help.

This can be frustrating, but the last thing you want to do is go under the knife when it is possible the next professional you visit could have prevented the surgery.

I recommend visiting at least 3 doctors before making your decision. The same can be said for therapist. If you have searched all over and exhausted several options, then it may be time to consider surgery.

3.You were in an accident

Most of the information on this site is geared towards those who have spondy’s that are affected by improper movement patterns, weaknesses, etc. Those who fall into this category have a high likelihood of finding improvement with non-surgical methods (if the right approach is taken).

Sometimes spondy’s are a result of blunt force or accidents. Car crashes, freak accidents such as ATV crashes, snowmobile accidents, falls on ice or even from extreme heights, etc all fall into this category.

Accidents such as these can lead to severe spinal injuries that are most likely not going to find much relief from non-surgical methods as the injury is a result of a single blunt force and not repetitive strain over time. These types of spondy’s should definitely consider surgical options if no relief is found thorugh non-surgical options.

4. Muscle weakness is progressing despite therapy or injections

Presence of pain in the legs may be a sign of compression of a nerve root that is exiting the spine. While pain sucks, having surgery to resolve it is considered an “elective” surgery.  There are plenty of conservative treatments (such as therapy, injections, etc) that have success in resolving the pain.

Presence of numbness or tingling in the legs may also be a sign of nerve compression at the spine.  It typically suggests a more “long standing” compression of the nerve.  It may be associated with or without pain.  If function is good (good mobility without pain) and muscles test strong with simple clinical tests, then numbness or tingling alone may not be a strong enough factor for a physician to want to operate.

However, progressive muscle weakness is a bigger deal.  It means the nerve isn’t getting any relief from compression.  Surgery may be needed in order to relieve the compression.  While it’s not “emergency” surgery (aka, your life isn’t threatened), waiting too long increases the risk of muscle function not returning.

An inability to raise the toes and ankle while sitting with the legs hanging over the edge of your bed are a sign of muscle weakness from nerve compression.  Another common sign is an inability to raise up onto your toes of one foot when standing (and holding onto a wall for balance).

Many times, injections or therapy will be tried, but may be termed “unsuccessful”.  Part of the problem is that muscle weakness is usually a sign of either significant or long-standing nerve compression.  If the nerve compression is reduced or completely resolved, the muscle weakness may still persist for weeks or months.  This damage from the compression is the slowest to return (in contrast, pain in the legs is the fastest symptom to change when compression is removed).  So even if therapy or injections are successful, the continued muscle weakness may give the impression of no change.

Surgeons will typically consider multiple findings in addition to muscle weakness, such as changes in pain, numbness, or changes in imaging studies (ex: MRI or CT scans), and your lifestyle needs.

5. You are just ready

Pain is exhausting.  Trying to battle it can be expensive — both financially and in terms of time.

I will always be an advocate of getting multiple physician opinions, trying various forms of treatment until your goals are met, and not assuming that “one therapist treats like all the others”.

You may visit 5 different physicians and be given 5 different paths for treatment.  You may visit 5 different physical therapists and experience 5 completely different types of therapy.  Those are good things.  No one type of treatment will work for all patients.  Any many times treatment with one professional may produce improvements, and adding a new therapist with a different skill set or perspective may “finish the job”.

However, you are more than just a diagnosis.  You have a lot of factors feeding into your decision for a surgery…

Family needs.  Work/job needs.  Other complicating factors in your medical history that may either make therapy less successful OR may make surgery less successful.

But just as important is how you are doing from an emotional perspective.  If you’re just flat out ready for surgery, and your physician feels it’s a strong option for you, then there is no “shame” in undergoing surgery.

You aren’t a “spondy”.  Always remember you’re a PERSON with a spondy and other needs that all factor in to the decision to have surgery.

There you have it, 5 reasons to consider spondylolisthesis surgery.

If you are to take only one thing away from this article, I encourage you to remember that not every spondylolisthesis patient is a candidate for surgery. Regardless of all the horror stories you read on forums and other websites surgery can sometimes be the right approach in certain situations.

The best plan of attack is to make sure you are knowledgable of the pro’s and con’s and most importantly, knowledgeable of your body and your exact spondylolisthesis situation.

For those that have had surgery, I encourage you to comment below with your story. If you are considering surgery, please comment as well with any questions or comments you may have.


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Leave A Reply (26 comments so far)

  1. chan pooi hoong
    7 months ago

    I had spongy for five years and deteriorating. Saw 6 spine surgeons and one neurosurgeon and all recommended sugary.

    Had L4/5 fusion in March 2015 and daily extreme pain ever since with pressure on pelvis and abdomen. Pain sitting, standing, walking and lying down. Causing digestive problems and chronic constipation.Never had an enjoyable meal since surgery.
    Loss of lordosis with extreme pressure on trochanter causing pain. The daily stress is getting to me with rashes in the thigh and back. I regret my surgery and wish the Lord will release me from this suffering.

    • SpondyInfo
      7 months ago

      Hi Chan,

      I am so sorry to hear about your pain and suffering. Feel free to email me with any questions. I wish I could help more!

  2. Carolyn Nelson
    7 months ago

    I had surgery March 17, 2016. My pain was increasing and it hurt to do simple things. I am a retired elementary physical education teacher. I have been active all my life. I was told by an EMG doctor that my MRI was so bad that I was in danger of loosing bladder and bowel control as well as my ability to walk. She said I don’t recommend surgery but you need to see a surgeon ASAP. I was sent to a surgeon who we decided after meeting with him to trust. On March 18th I got out of bed and my pain was gone. I am almost at my one year anniversary and feel I have my life back. I now walk 36 minutes a day and bike. My only restriction is to use common sense which at 70 is much wiser than in my younger days. I did try all kinds of things from injections to inversion tables. Surgery was the answer for my problem. I have decided that St. Patrick’s Day is my favorite holiday now.

    • SpondyInfo
      7 months ago

      Hi Carolyn.

      Thanks so much for sharing! Keep improving and Happy St. Patrick’s Day!

  3. John Buch
    7 months ago

    Great “objective” analysis. To me surgery has always come down to “pain and lifestyle” with finances getting a close 3rd place but with spondy now you have to add the fact there may be irreparable damage if surgery is put off too long. JB

    • SpondyInfo
      7 months ago

      Great points. Thanks JB!

  4. margaret barnes
    7 months ago

    I found this blog very informative. I am not sure what grade I have but have taken steps to find out.
    I have multi level degenerative changes with degenerative scoliosis and a slight anterolisthesis of L4 over L5 radiculopathy on the right. I have quite bad nerve pain going down my leg but not constant just when I am walking a lot or doing household chores. I am quite fit sixty eight year old and do aqua fit exercise and over fifty exercise class twice a week. Neuro Surgeon could not guarantee operation would not give me more back pain but would help leg pain but I might not have same level of fitness as I have at the moment. I do not know what to do for the best, and am not sure what exercise I should be doing or what to avoid.

    • SpondyInfo
      7 months ago

      Hi Margaret. If you are curious to find out what exercises are best for your specific situation I would recommend seeing a board certified physical therapist who is also certified in the SFMA or PRI methods. They will be able to take a look at you and know what specific weaknesses should be addressed through exercise. Here is a helpful article that will point you in the right direction:


      Thanks for posting!

  5. Joe Moore
    7 months ago

    Well, I made the decision and have surgery next week. I have Grade I L4-5 that is unstable. The back pain comes and goes but it is the bi-lateral pain in the glutes, hamstrings, calves following any activity that is becoming very limiting. I’ve tried several years of chiropractic care, different physical therapists, injections, and daily core and strengthening exercises at home, plus visits to three surgeons. The only thing that really helps is the daily routine of home-based exercises. Im 64 and have always been very active with cycling, hiking, skiing, and kayaking and am becoming limited in doing those things. I know surgery carries no guarantees, but for me, my personal quality of life is becoming limited, and I have to try and move forward.

    • SpondyInfo
      7 months ago

      Thanks for sharing Joe. It sounds like you have done a great job giving non-surgical options a try. Sometimes, surgery is the best option. I wish you the best and please follow up with us and let us know how it goes!

  6. Jim Noyes
    7 months ago

    Symptoms crept up over the aging years….tingling legs etc. Then they started to get really annoying with intermittent discomfort in hamstrings and calves. In Oct ’15 diagnosed with spondylolisthesis L4-L5-S1. Tried to ward off surgery with PT. Event in Jan ’16 put me in the ER for IV prednisone. Bent over to pick up a frisbee and couldn’t stand up. Again, trierd to ward off surgery via PT, Pilates, clean living etc. Symptoms returned but seemed moreorless tolerable. Another event in Sep ’16 put me back in the ER. Got out of a car after a long drive and couldn’t stand up. In Oct ’16 had laminectomy, discectomy and spinal fusion surgery. While 30-day recovery/rehab challenging with no bending, lifting, twisting was completely off pain meds after that, feeling quite normal after 60-days and pretty much resuming regular activity after 3-months with common sense being my only regulator as there has been no pain nor symptoms. So, the surgery worked for me when all else didn’t. Recommendation….make sure you get a top-flight surgeon in a top-flight facility.

    • SpondyInfo
      7 months ago

      Thanks for sharing Jim. Great tip!

  7. Laura
    7 months ago

    I would also add a sixth situation: Your spondy is unstable. I am now 5 weeks out from surgery, and that is what tipped me over into the decision to go for surgery. I have had a spondy at about 50% displacement (borderline grade 2/3) for several decades. I have been able to deal with the back pain with exercises for most of that time. However, I am 62 now, and over the past couple of years have started experiencing more neurological involvement in my legs. A year ago, a spine specialist pointed out to me that when I was lying down with my feet up during the MRI the displacement was 25%, whereas when I was standing with my arms over my head during one of the X-rays it was a little over 50%. In other words, the segment (L5/S1) was actively sliding throughout the day. This, in addition to nerve impingement caused by scar tissue and arthritis, was causing my misery.

    It is too early to say whether the surgery will have the results of my dreams. I can say that I am over the worst of the post-op nastiness and am feeling a little better each day. I’d be happy to report on my progress if people are interested.

    • SpondyInfo
      7 months ago

      Fantastic point Laura. Having an unstable spondy makes it much harder to find relief through non-surgical methods. Those with instability have greater shifts, greater chances of nerve pain and are candidates for surgery. Thanks again for pointing this out!

  8. Allison Garrott
    7 months ago

    Justin, Thank you so much for your sound thinking and advice about this condition. My Spondy is not very troublesome at this point, and I exercise regularly to strengthen my core and back, etc.
    However, I do have flare ups periodically and it always encourages me to know you are there to help.

    • SpondyInfo
      7 months ago

      Thanks for the kind words Allison. Keep improving and learning what causes your flare ups. The more accurately you can pinpoint the causes, the better you can begin to understand what it is that is leading to them and how to improve the weaknesses associated with the causes.

  9. Brooke
    7 months ago

    I had spondy surgery in May of 2016. It was a tough decision to make, but my deciding factor was that I was in pain virtually every hour of every day and it was affecting everything I did-sleeping, walking, sitting, exercising, etc. I had tried other techniques for pain management, but my pain only progressed. At the age of 21, I had surgery to correct my grade 4 spondy. While I am very young to have spondy, I have dealt with it for many years. With the progression of pain, surgery was the only thing to help. I met with multiple surgeons and found one that seemed like a good fit for me. They had concerns that they would need to fuse an extra vertebra up due to the severe downward curve of my spine. Thankfully, they could complete the surgery only fusing the 2 vertebrae; however, because of this, one of the screws did not hold in place. As of now, the screw is slightly in place and causes some discomfort, but compared to my pain before, the surgery has been a blessing. I am so glad to have chosen surgery for my situation. Of course, the younger you are, there may be a quicker recovery, but there is also more likelihood for future surgeries due to deterioration in vertebrae above the fusion, so it is something I must be aware of and try to limit my exercise dependent on pain and put minimal pressure onto my back. For those considering surgery, think about how much of your day is spent in moderate-severe pain. If it seems like a lot of your day, it may be time for surgical consultations!

    • SpondyInfo
      7 months ago

      Thank you so much for sharing Brooke!

  10. elias
    7 months ago

    I have been a fanatic of the gym and kickboxing for the last 40 years. I am now 60.
    I started having a certain numbness in my left foot two years ago. I went to see a chiropractor and told me to have a tomography. After seeing it he said i needed to see a neurosurgeon. I went and saw 6 of them and they all wanted to perform fusion surgery on my back and when i watched such surgery procedure on the internet, which included drilling in my spine, i said “no way”…until i found a cuban neurosurgeon who told me that i only have grade 1 spondylisthesis and needed no surgery and had to continue doing exercises to strengthen my back but no kickboxing against punching bags… i followed his advice and now i continue exercising, but not intensively and am doing great…be careful with neurosurgeons…their job is to cut and drill, that is the way they earn their living
    By the way, your series of exercises have helped me a lot…a million thankst!!!

    • SpondyInfo
      7 months ago

      Thanks for sharing Elias. You make a great point…Visiting both surgeons and doctors who do not perform surgery is an important step. And you are likely to get different advice. The more information you can collect, the better decision you can make.

  11. Creth Holman
    7 months ago

    I had a major surgery for my spondylolisthesis on Jan 9th which ended up as an L3 Ilium Fusion.
    I now have screws and rods trying to pull the L5 up that had fallen between 50 to 70 percent.
    Surgery was 5 hours and I was told it went well. Five days later they opened my back up
    for an hour surgery to correct a leakage causing a fluid build up at the incision site. Again
    I was told everything went well. I was release 3 days later and was told that since I was getting around fairly well that physical therapy was not needed. Two days later, I had a lot of swelling and
    pain in my left leg, and basically have lost 75% use of that leg. Surgeon ended up giving me an
    order now for physical therapy, and PT is telling me my muscles are so weak that my leg has only minimal motion. This is totally strange to me since the day before the surgery both legs were working great. Surgeons are not accepting any responsibility that the surgery could have caused this. I’m calling BS on this. PT is telling me that with enough time the leg may come back, but it will be a long time. Along with the pain and not being able to use the leg, I am dealing with a lot of neuropathy pain. I’m taking Gabapentin which works sometime. This kind of constant pain keeps me up at night allowing only 2 to 3 hours of sleep It’s going to be a long process to try and restore the use in that leg. I went into this processto try and get rid of some back pain, but if I had it to do over again, I never would have had the surgery. Please talk with with your surgeons before going under the knife about everything that possibly can go wrong.

    Creth Holman
    Salisbury, NC

    • SpondyInfo
      7 months ago

      Hi Creth. I am sorry to hear about your situation. Thank you for taking the time to share with others and thanks for the point about making sure you discuss all options with surgeons. It is a very, very important point. I wish you the best of luck with your recovery.

  12. Steve L
    7 months ago

    Hello Everyone,
    I have a grade 1 spondy at L5-S1 and was diagnosed about a year and a half ago. I appreciate all of your comments and it’s helpful to me to read about the success stories as well as the surgeries that haven’t helped. My pain comes and goes. Standing and walking for too long seems to exacerbate it. So far, no surgery but the pain, lately, has been pretty persistent: about a 3/4 on a scale of 1-10 (10 being the worst). Sometimes it disappears for weeks but invariably returns. I’m doing home exercises, yoga and a lot of core strengthening. I’m very determined as I’m very nervous, as I’m sure you all were, about having surgery. I would appreciate it if those of you who have had surgery, would continue to post on your progress. Thanks for the commentary, too, Justin. It’s very helpful and encouraging as I’m working with an SFMA and board certified PT.

    • SpondyInfo
      7 months ago

      Hi Steve. Surgery can be a very nerve racking thing. I encourage you to keep pushing forward and working with your SFMA and board certified PT. Be open with them about your progress. If you feel something is not working or helping you, be honest and discuss this with them. Hopefully they were able to find weaknesses that have been contributing to your discomfort. Improving these weaknesses do not happen over night, they can take time. The good news is you have a grade 1 spondy, which puts you in a category that studies have shown has a much better chance of improving with non-surgical approaches when compared to higher grades. Keep working and try to remain positive. Best of luck!

  13. Lori
    5 months ago

    I am 57 and I had surgery ( laminectomy and fusion of L 4&5) this last August after everything became to much to “manage” anymore. I did everything right for several years and then had to take the next step. I researched the heck out of the different types of fusion surgeries. Researched fusion VS no fusion. Jumped through all the “conservative” hoops the physical medicine doctor needed to show I did. Most I was already doing such as Chiro, massage, acupuncture, exercise, diet. I refused injections for several reasons. I was ready but I did not have a surgeon. Finding the right surgeon is something you need to take very serious. I knew I was ready. I was in great health. I had none of the reasons these surgeries fail such as being overweight, poor diet, diabetic, smoker, poor bones etc. It took me a few months to pull the trigger. I had an amazing surgeon through Kaiser Southern California. I did what I was told as far as no lifting, bending twisting then started PT at 6 weeks. Was off all meds by 6 weeks and at 6 months my X-ray shows no movement and I am pain free. I’m back in my garden. I’m back walking long distance. At one year, If all is still well, which my surgeon has no reason to believe it won’t be I will be considered fully fused and a back surgery success. I am so glad I did it. I have more energy. The heavy legs and nerve pain zapped my energy. Most of the stories on line are negative. You need to realize there are many many positives out there. The success stories are too busy getting on with life to sit and complain on line. It’s 100% your physical status and 100% a good surgeon.

    Lori A.

    • SpondyInfo
      5 months ago

      Fantastic post Lori! Thank you so much for sharing. You make some great points and I think it is worth repeating how important it is to due your research when it comes to finding a surgeon. Also, you point about negative comments on the internet is spot on. Those that are happy rarely take the time to comment on positive experiences, while those that are negatively affected go out of their way to share their horrible experience. Thanks so much for sharing and I hope other readers find your recommendation helpful!

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