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This consists of exercises to strengthen the abdominal muscles (eg, William flexion-type exercises) and flexibility programs to stretch the spinal extensor muscles, hamstrings, and lumbodorsal fascia.
Surgery is indicated if the slippage is greater than 50% or in cases of refractory symptoms or progressive neurologic deficit.
For specific procedures, see Treatment, Acute Phase, Surgical Intervention.
In an asymptomatic child with slippage up to 25% (grade 1), initially observe with radiographs every 4-6 months if younger than age 10 years, semiannually until age 15 years, then annually until the end of growth.
No limitation of activities is required, but the patient is advised to avoid occupations that entail heavy labor.
Recommend that the patient continue with his or her home exercise program, focusing on lumbar stabilization to reduce biomechanical stresses (particularly extension) in the lumbosacral spine.
The program should continue to include both stretching and strengthening exercises.
The athlete now starts to focus on sports-specific retraining, with attention to skill and technique refinement.
Similar recommendations are continued in the maintenance phase as compared with the acute and recovery phases.
The postoperative rate of permanent neurologic deficits is high (25-30%), although many are preexistent.
This does not appear to be balanced by improved results; fusion in situ has achieved similar clinical outcomes with a lower complication rate.