This is a critical post for people with spondylolisthesis.  If you don’t already know my professional background, I spent 18 years in orthopedics, physical medicine and physical therapy.  I also spent 4 years, part-time, in a neurosurgical practice learning surgical indications and procedures.  In fact, this was with the Atlanta Falcon’s team neurosurgeon, Dr. Kaveh Khajavi.  He happens to specialize in minimally-invasive, lumbar fusions to correct spondylolisthesis.  He is a wonderful surgeon, and a most generous medical professional.

The point is, there is a time for surgery for spondylolisthesis, and you need a trustworthy and especially-knowledgeable doctor’s help to know when surgery is indicated.  I can usually, effectively, treat grade 1 slips- in fact, most grade 1 slips have been present for decades and may be asymptomatic.  Grade 2 slips are usually surgical- though not always.  The surgical decision is not possible to distill into a simple, definitive, algorithm.  It’s best to discuss in a dialogue with the patient.

Although I am a non-surgical, medical provider, because of my unique, professional experience, I can competently inform, and advise, patients regarding surgery and the need for a surgical consult.  In fact, many patients that I have seen consider my surgical recommendation to be valuable, because I don’t have a financial gain from recommending surgery.  And, in fact, I do often recommend surgery for patients.  In fact, most patients tell me that I explain the surgery more thoroughly than the surgeon and his medical staff.  That’s not meant to be an unfair criticism of surgeons.  It’s just the reality that I’m good at teaching patients, and that surgical offices and staffs have less time than I do.

So if you have spondylolisthesis, please come to see me, and I’ll let you know if surgery is avoidable or necessary.

Best wishes, Dr. Castanet.