What are considerations in treatment selection for lumbar spondylolysis and spondylolisthesis?

Updated: Jul 08, 2020
  • Author: Beth B Froese, MD; Chief Editor: Stephen Kishner, MD, MHA  more...
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Answer

Surgical treatment is indicated when any type of spondylolisthesis is accompanied by a neurologic deficit. Persistent disabling back pain after conservative management may be considered an indication. High-grade slips (greater than 50%) more commonly require surgical intervention. Traumatic spondylolisthesis is rare but almost always requires surgical stabilization. [2]

A literature review by Longo et al suggested that in patients with high-grade spondylolisthesis, surgical treatment with reduction followed by arthrodesis may be more beneficial than arthrodesis in situ. The report was based on eight studies, involving a total of 165 operations in which reduction was performed prior to arthrodesis and 101 surgeries in which patients underwent arthrodesis in situ, with no reduction performed. The investigators found that in the patients treated first with reduction, the percentage of slippage and slip angle and the frequency of pseudarthrosis were significantly lower than in the arthrodesis in situ patients. Moreover, there was no significant difference between the two groups with regard to the prevalence of neurologic deficits. [19]


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