What is the prognosis 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

In general, patients with grade 1 or grade 2 isthmic slips do quite well with conservative management. Patients may return to play once they are asymptomatic. A flexion-based home exercise protocol is vital. Overall long-term outcome is quite favorable, specifically with lower grades of listhesis not accompanied by neurologic impairment.

A literature review by Overley et al found that among adolescent athletes with symptomatic spondylolysis but without spondylolisthesis, rate of return to play after nonoperative treatment was 92.2%, compared with 90.3% after surgical management. [22]

A study by Yamazaki et al indicated that in pediatric and adolescent athletes with spondylolysis, the likelihood of bone healing is negatively impacted by a high defect stage, a high contralateral pars interarticularis defect stage, and poor flexibility. For example, for very early stage contralateral pars interarticularis defect, the bony-union rate was 84.2%, compared with 37.1% for the progressive stage. [23]

Higher grades of isthmic spondylolisthesis have a variable prognosis with regard to persistent low back pain. Surgical intervention does provide nice improvement in claudication or radicular symptoms. Diskogenic pain may produce more persistent lower lumbar discomfort.

Patients with degenerative spondylolisthesis seem to have persistent waxing and waning pain originating from the facet joints. Surgical decompression for neurologic compromise has a high rate of success in relieving lower extremity symptoms. A literature review by Joaquim et al indicated that in degenerative lumbar spondylolisthesis, decompression alone, without instrumented fusion, may be a useful treatment in some patients. The data suggested, however, that long-term outcomes may be better with fusion. The investigators suggested that isolated fusion may not be suitable in patients with a facet angle of greater than 50°, a disk space of greater than 6.5 mm, low back pain (in contrast to lower extremity symptoms), hypermobility at the listhetic level (>1.25-2 mm) on dynamic radiographs, and resection of the posterior elements. [24]

A prospective, randomized, controlled trial by Inose et al reported that for low-grade (< 30%) degenerative lumbar spondylolisthesis, outcomes for decompression plus fusion or decompression plus stabilization were no better at 1- and 5-year follow-up than for decompression alone. [25]

However, a study by Haddas et al indicated that in patients with degenerative lumbar spondylolisthesis, decompression plus fusion surgery significantly improves stance stability. The investigators reported that following treatment, range of sway for the center of mass and head were reduced in the sagittal, coronal, and axial planes, with total sway for the center of mass and head also decreased. Nonetheless, total sway did not shrink to the levels of normal controls, and range of sway in the sagittal head was also greater than in controls. [26]


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