Can Spinal Decompression Make Spondylolisthesis Worse? San Diego, CA

What You Need to Know

Is Spinal Decompression a Recipe for Disaster if One of Your Vertebrae Is Already Slipping Forward?

It's one of the first questions many patients with spondylolisthesis ask:

“If one of my vertebrae is already slipping forward, couldn't spinal decompression make it slip even more?”

It's an important question—and the answer isn't simply based on whether you've been diagnosed with a Grade 1 or Grade 2 spondylolisthesis.

One of the most important factors is stability.

At The Spinal Decompression & Chiropractic Center of San Diego, Dr. Cassidy James Boelk, DC routinely evaluates patients who have been diagnosed with spondylolisthesis and are trying to determine whether they have non-surgical treatment options.

And this particular condition is personal for him.

Dr. Boelk has a Grade 2 spondylolisthesis himself.

His is stable.

That distinction—stable versus unstable—is one reason Dr. Boelk routinely uses weight-bearing flexion and extension X-rays when evaluating patients with spondylolisthesis before considering Non-Surgical Spinal Decompression.

Because the question isn't simply:

“What grade is my spondylolisthesis?”

A better question may be:

“Is my spondylolisthesis stable, and am I actually a candidate for Non-Surgical Spinal Decompression?”

If you've been diagnosed with spondylolisthesis and want another opinion about your non-surgical options, call 619-298-0800 to schedule a No-Charge Consultation with Dr. Boelk.

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What Is Spondylolisthesis?

Spondylolisthesis describes a condition in which one vertebra has shifted relative to the vertebra below it.

It is commonly discussed according to the percentage of slippage.

A lower-grade spondylolisthesis does not necessarily tell us everything we need to know about how that spinal segment is functioning.

Two patients can both be told they have a Grade 1 spondylolisthesis, for example, while having very different clinical situations.

One may demonstrate relatively little abnormal movement.

Another may show meaningful movement of the involved vertebra when bending forward and backward.

That's why looking at the grade alone may not be enough.

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Stable vs. Unstable Spondylolisthesis: Why It Matters

When Dr. Boelk evaluates a patient with spondylolisthesis, he doesn't simply want to see where the vertebra is positioned while the patient is lying still for an MRI.

He also wants to understand:

What happens to that vertebra when the patient moves?

That's where weight-bearing flexion and extension X-rays can become extremely valuable.

These X-rays allow the spine to be evaluated while standing in different positions.

Dr. Boelk can compare how the involved vertebra behaves during flexion and extension and determine whether there appears to be significant abnormal motion.

This information can substantially change the treatment conversation.

If Dr. Boelk identifies significant instability, he is NOT going to put that patient on spinal decompression.

That patient may require a different approach and, depending on the findings and symptoms, additional evaluation by an appropriate medical specialist.

But a stable Grade 1—or a carefully selected stable Grade 2 spondylolisthesis—may be a very different situation.

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“I Have a Grade 2 Spondylolisthesis Myself.”

Dr. Boelk's interest in this condition isn't purely academic.

As a teenager, he suffered a significant spinal injury and ultimately developed a Grade 2 spondylolisthesis at L5-S1.

Today, that spondylolisthesis remains stable.

Rather than ending his active lifestyle, the injury became one of the reasons Dr. Boelk spent thousands of hours studying spinal rehabilitation, stability, exercise and Non-Surgical Spinal Decompression.

He continues to remain active, including working out, surfing, golfing and playing hockey.

That experience has also influenced an important part of his clinical philosophy:

Having spondylolisthesis doesn't automatically tell us what someone can or cannot do.

The details matter.

The patient's symptoms matter.

Their neurological findings matter.

Their imaging matters.

And stability matters.

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Why Would Someone With Spondylolisthesis Even Consider Spinal Decompression?

This is another important distinction.

The goal isn't necessarily to “push the slipped vertebra back into place.”

That's not how Dr. Boelk approaches these cases.

Patients with spondylolisthesis can also have other spinal problems contributing to their symptoms, including:

• Disc degeneration

• Disc bulging or herniation

• Loss of disc height

• Foraminal narrowing

• Nerve irritation

• Sciatica

• Chronic low-back pain

• Pain traveling into the buttock or leg

In an appropriately selected patient with a stable spondylolisthesis, Dr. Boelk may consider whether Non-Surgical Spinal Decompression could be useful for associated disc and nerve-related problems.

But that decision comes after determining whether the patient is an appropriate candidate.

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Can Spinal Decompression Make Spondylolisthesis Worse?

This is the question that brought many people to this article.

And it's exactly why Dr. Boelk does not recommend spinal decompression based simply on a diagnosis.

If a patient has meaningful instability, that changes the risk-benefit discussion substantially.

Dr. Boelk's approach is straightforward:

Significant instability? No spinal decompression.

But the presence of a stable Grade 1—or even certain carefully selected stable Grade 2 cases—doesn't automatically answer the question in the opposite direction either.

Those patients still require an appropriate history, examination and imaging review.

Spondylolisthesis isn't a condition where every patient should be treated the same way.

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Why an MRI May Not Answer the Stability Question

MRI can provide extremely useful information about the discs, nerves, spinal canal and other structures.

But a conventional MRI is generally obtained while you're lying down and relatively still.

If Dr. Boelk wants to understand what happens to a spondylolisthesis during movement and weight bearing, he may need different information.

That's one reason standing flexion and extension X-rays can be an important component of his evaluation.

They allow him to look at the involved spinal segment under different mechanical conditions.

An MRI and weight-bearing X-rays therefore aren't necessarily answering the same question.

Dr. Boelk may want information from both.

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What About a Pars Defect or Pars Fracture?

Some cases of spondylolisthesis are associated with a defect in an area of the vertebra known as the pars interarticularis.

Other cases can occur without a pars defect.

This distinction may be important when evaluating the type of spondylolisthesis and overall spinal mechanics.

Again, this is why Dr. Boelk doesn't believe the words “Grade 1” or “Grade 2” provide enough information by themselves to determine treatment.

The type of spondylolisthesis, symptoms, imaging findings, neurological status and stability all need to be considered.

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Not Every Patient With Spondylolisthesis Is a Candidate

This may be the most important part of this entire article.

Dr. Boelk does not accept every spondylolisthesis patient for Non-Surgical Spinal Decompression.

If the evaluation identifies findings that make decompression inappropriate, he will tell you.

Depending upon the situation, he may recommend additional imaging or consultation with another medical specialist.

That's not a failure of treatment.

That's appropriate patient selection.

And when dealing with a vertebra that has already shifted from its normal position, patient selection matters.

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Why Patients With Difficult Spinal Conditions Seek Out Dr. Cassidy James Boelk, DC

Dr. Cassidy James Boelk, DC is a Certified Spinal Decompression Doctor and Certified Pain-Free Performance Specialist who has spent more than two decades working with difficult back, neck and disc-related conditions.

His experience includes his own Grade 2 spondylolisthesis and thousands of hours spent rehabilitating and learning how to manage his own spinal injuries while remaining active.

Dr. Boelk also trains other doctors in Non-Surgical Spinal Decompression protocols and techniques through the Non-Surgical Spinal Decompression Training Academy, which he founded at his private practice in San Diego.

The Spinal Decompression & Chiropractic Center of San Diego has seven Non-Surgical Spinal Decompression systems—four lumbar and three cervical—and exclusively utilizes DRX9000 technology.

Patients seek out Dr. Boelk from throughout San Diego County, other parts of California and, in some cases, from other states and countries.

But regardless of where someone comes from, the first question remains the same:

Is this patient actually a candidate?

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Questions to Ask If You've Been Diagnosed With Spondylolisthesis

If you've recently been told you have spondylolisthesis, don't stop at asking:

“What grade is it?”

Consider asking:

• Is my spondylolisthesis stable or unstable?

• Does it move significantly during flexion and extension?

• Do I have a pars defect?

• Do I also have a disc bulge or herniation?

• Is there foraminal narrowing?

• Is a nerve being irritated or compressed?

• Are my symptoms actually coming from the spondylolisthesis?

• Am I an appropriate candidate for conservative treatment?

• Are there reasons Non-Surgical Spinal Decompression would be inappropriate for me?

The answers to those questions can tell you much more than the grade alone.

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Do You Need Surgery for Spondylolisthesis?

Some patients with spondylolisthesis absolutely need surgical evaluation.

Progressive neurological deficits, significant instability or other concerning findings may change the treatment options considerably.

But simply being told you have a Grade 1 or Grade 2 spondylolisthesis does not, by itself, tell you what treatment you need.

If your condition appears stable and you are trying to avoid surgery, it may be reasonable to determine whether appropriate non-surgical options exist.

The key is proper evaluation and patient selection.

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Have Spondylolisthesis? Find Out If You're Actually a Candidate

If you've been diagnosed with Grade 1 or Grade 2 spondylolisthesis and you're worried that spinal decompression could make the problem worse, don't guess.

Find out whether your spondylolisthesis is stable.

Find out what's actually causing your symptoms.

And then find out whether you're an appropriate candidate for Non-Surgical Spinal Decompression.

Schedule a No-Charge Consultation With Dr. Cassidy James Boelk, DC

The Spinal Decompression & Chiropractic Center of San Diego

Dr. Cassidy James Boelk, DC
Certified Spinal Decompression Doctor
Certified Pain-Free Performance Specialist
Founder, Non-Surgical Spinal Decompression Training Academy

5095 Murphy Canyon Road, Suite 300
San Diego, CA 92123

Office: 619-298-0800
Office Cell: 619-884-8298
SanDiegoBackCare.com

Call 619-298-0800 to schedule your No-Charge Consultation.

Not everyone with spondylolisthesis is a candidate for Non-Surgical Spinal Decompression—and that's exactly why determining stability comes first.

This article is for educational purposes and is not intended to diagnose or treat an individual condition. Individual results and treatment recommendations vary.