Recently there have been many patients with low back pain coming to the clinic, and upon arrival they say, “Doctor, I have lumbar spondylolisthesis, can I not have surgery?” In fact, there are many patients with lumbar spine slippage and lumbar instability, most of them with simple mild slippage do not need surgery, so what kind of slippage? Which slipped lumbar spine patients with slipped symptoms need surgery? Let’s first get to know our lumbar spine. We generally have 5 lumbar vertebrae, some people will have sacral lumbarization or lumbar sacralization variants, then these people will have 6 or 4 lumbar vertebrae, these variants are normal if there are no symptoms, there is no need to worry too much. The main function of our lumbar vertebrae is to support our body, protect the spinal cord and nerves, and protect our abdominal organs, etc. Each of our lumbar vertebrae consists of a vertebral body in the front and a vertebral plate located in the back, an articular process, a spinous process and an arch that connects the front and the back structures, while the spinal cord and nerves are located inside the spinal canal, a tube composed of the vertebral body, the arch and the vertebral plate, and the upper and lower arch in the lower back. There is a relatively weak part called the isthmus between the upper and lower synapses of the vertebral arch, and this isthmus is the hub connecting the anterior vertebral body and the posterior structures such as the posterior vertebral plate and spinous process, and it is a place where the force is concentrated, and at the same time, the isthmus is also a relatively weak mechanical point, and if the isthmus is broken or stretched, it will cause the anterior vertebral body to be dislocated and separated from the anterior and inferior, and this is lumbar spondylolisthesis. So what are the symptoms of lumbar spine slippage? Because the arrangement of the lumbar spine has changed, its weight-bearing function has been reduced, so the stress on the muscles, ligaments and soft tissues around our lumbar spine will be increased, which will produce fatigue and strain over time, which will produce pain, soreness and other uncomfortable symptoms, so the first and main symptom of lumbar spine slippage is pain and soreness in the lower back. At the same time, as the upper lumbar spine body slips forward, the spinal canal becomes smaller and narrower, so that the nerves located in the spinal canal will be elongated and compressed, and the symptoms of nerve damage in the legs, such as leg pain, leg numbness and intermittent claudication, will occur. How is a lumbar spondylolisthesis classified? What kind of slippage requires surgical treatment? According to whether the isthmus is broken or not, lumbar spine slippage is divided into true slippage and pseudoslippage. A slippage with a broken isthmus is called a true slippage, while a slippage caused only by the elongation of the isthmus is called a pseudoslippage; according to the degree of slippage, it is divided into slippage of degree I to IV. For true slippage, the separation of the anterior and posterior structures after the isthmus rupture is generally progressive, while for pseudoslippage, the majority of patients with I degree slippage will not progress if the isthmus rupture does not occur after good maintenance and treatment, although it may develop into an isthmus rupture and become a true slippage if the factors that cause the isthmus to become more stressed cannot be removed. In all cases of lumbar spine slippage, most of the slippage is pseudosynovial and true slippage of degree I. After the above analysis, you should have a clear understanding of the slippage of the lumbar spine. Then, our treatment is based on the type and trend of the slippage, and we can consider conservative treatment for pseudoslippage without spinal stenosis and nerve compression symptoms and true slippage of degree I with only one side of the isthmus rupture. For a true slip of degree I with bilateral isthmus rupture, a slip of degree II or greater, and a slip with significant spinal stenosis and nerve compression, surgical treatment is required. For most of the patients with I degree slippage without nerve compression and spinal stenosis, conservative treatment can also achieve good results, so how to conservative treatment? 1, must remove the factors that can lead to aggravation of the lumbar force, this is the most important, specifically is usually to minimize the bending action. Experimental studies have found that the human body needs to bear several times and more than ten times the stress on the lumbar spine when bending, so try to bend as little as possible, at the same time, try not to bend to lift or lift heavy objects; 2, must strengthen the functional exercise of the muscles of the lumbar back, the muscles of the lumbar back is strong, the force on the isthmus of the lumbar spine will be reduced, so that the chances of further elongation or fracture of the isthmus will be reduced; 3, if there is low back pain and lumbar pain and swelling If you have back pain and back pain, you can take oral symptomatic treatment; 4. You can also take physical therapy. For bilateral isthmus ruptures of degree I and II or more, as well as slippage with obvious nerve compression and spinal stenosis, surgical treatment is required. Our surgery is mainly performed for two reasons: one: to stabilize the slipped and unstable lumbar spine, so that we have to fuse and fix it; and two: to decompress the nerves. Nowadays, surgical methods and equipment have been greatly improved compared to traditional surgical methods, and most patients can get out of bed 2 to 3 weeks after surgery, so don’t have a lot of fear about surgery.