Dr Adriaan Liebenberg My Spine Explained | Page 45

My Spine Explained
There are generally only two indications for an operation. The first is ongo-
ing disabling back pain that is not relieved by any conservative measure and
a definite loss of quality of life. The second indication is impending perma-
nent nerve damage. This is usually indicated by sciatica (radicular pain) or
dysfunction of the nerves that supply the bladder and the bowel as well as
sexual function (see the chapter Back Pain and Neck Pain). The sacral nerves
supply the outonomic (automatic) function of bowel, bladder and sexual
function and can be compressed if the listhesis is severe.
The first part of the operation is a decompressive procedure to free the nerves
and this is supplemented by a pedicular screw spinal fusion. This is necessary
because the spine is even further destabilised by doing the laminectomy.
Please see the relevant chapters for a description and explanation of these
operative procedures.
Does this treatment have any complications?
The only complication of conservative therapy is the fact that it might be
unsuccessful and therefore not prevent a spinal operation. It should, how-
ever, in the absence of impending permanent nerve damage, be the first line
of treatment.
What are the long-term expectations?
For Grade I and II spondylolisthesis conservative therapy can be successful
in up to 80% of cases. Surgical treatment can be successful in up to 90% of
people. There has to be an ongoing commitment from the patient to strength-
en their back and to apply good back habits for the rest of their lives (see the
chapter Everyday Life).
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