The treatment would depend on the duration of your problem, whether your pain is purely localized to the lower back or whether it radiates down to the lower limbs, neurological function, response to previous nonoperative treatment and lastly, the subjective severity of your pain. Various nonoperative means of treatment include bed rest, painkillers, muscle relaxants, various modalities such as heat and electrical stimulation, activity restrictions, etc.
For cases of spondylolysis, complete bed rest is helpful. For spondylolisthesis however, complete bed rest may not really be effective. How should you sleep? You should sleep on your side, either right or left, whichever is comfortable, with a pillow in between your legs. What kind of bed should you sleep on? A cotton mattress is ideal! No need to sleep on hard beds, nor do you need to fall for any kind of so-called “spine-friendly” expensive mattresses sold out in the market! This bed rest should be for a period of 2-3 days. During this period, you should eat, drink and sleep in the bed. Only sponge bath is allowed. Ideally, you should not get up even to visit the washroom; you should use a bedpan or urine-pot. However, if this is too much of an inconvenience, you may be allowed to get up to use the washroom alone. How long should you take bed rest? If the pain has to respond to bed rest, it will do so within 2-3 days; continuing beyond this much time only further weakens your spinal muscles without really decreasing your pain; in other words, beyond 2-3 days, complete bed rest will do more harm than good to your back.
Painkillers will be prescribed bt your spine surgeon or spine consultant to allow a smoother and easier return to normal function. You would generally be prescribed these by your spine specialist on a shorter term or on a longer-term tapering program so as to guard against possible over dependence on these agents, as these are associated with significant side effects if used excessively in the long term. These side effects may range from hyperacidity, gastric ulcer, kidney damage, bleeding disorders, constipation, addiction, etc. In addition, based on individual merit, you may also be prescribed muscle relaxants so as to relax and soothe your back muscles. This is so because whenever you have back pain, your muscles tend to go into spasm [sustained contraction] and hence, lead to pain. It is essential to break this spasm with a muscle relaxant so as to give effective pain relief.
Physiotherapy modalities may be used. This consists broadly of passive and active physiotherapy. During acute pain, generally, only passive physiotherapy would be used. This would be in the form of heat in various forms or electrical stimulation in various forms such as SWD [short-wave diathermy], TENS [transcutaneous electrical nerve stimulation] and IFT [interference therapy]. After pain relief, you would be prescribed active physiotherapy i.e., spinal flexion exercises. This exercise protocol is the most effective tool in the nonoperative treatment of this problem.
Though complete bed rest would be prescribed only for 2-3 days, you would need to have some activity restrictions to help your spine get back into shape and stay that way!! You would not be allowed to bend your spine backwards or get involved in sports that lead to such a kind of movement such as gymnastics, fast bowling in cricket, soccer, golf, etc. These restrictions would be generally enforced for a minimum period of about one month. Smoking would be forbidden lifelong! You may be prescribed a brace for a short period of time. This brace would generally need to be worn at all times other than while lying down.