Spondylolisthesis Treatment After Epidural Steroid Injection Has Not Worked
Clinical Scenario
This protocol applies to patients with spondylolisthesis whose conservative injection therapy did not provide adequate benefit — leaving low back pain, radicular symptoms, or instability unresolved and requiring a next treatment step.
Previous Treatment — Insufficient Response
Epidural steroid injection with methylprednisolone into the epidural space failed to achieve its targets of short-term pain reduction and functional improvement. This failure of conservative injection therapy is the clinical trigger for escalation to the structured protocol below.
Next-Step Approach (Partial Overview)
The protocol advances to a surgical strategy centred on spinal decompression, with or without additional stabilisation — the specific approach, its indications, and the decision criteria are detailed in the full regimen.
- Low back pain relief
- Resolution of radicular symptoms
- Spinal stability
References
DOI: 10.25122/jml-2025-0039
- Surgical management of spondylolisthesis typically involves either decompression alone in cases where nerve root or spinal cord compression is the primary concern or decompression combined with spinal fusion to restore stability and prevent further slippage.
- The primary decompression techniques used are laminectomy, which relieves spinal canal stenosis, and foraminotomy, which reduces nerve root compression.
- Posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF) are two widely utilized surgical techniques for stabilizing the spine in patients with spondylolisthesis.
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