Degenerative Lumbar Spondylolisthesis: Treatment Strategies

Abstract

Degenerative lumbar spondylolisthesis is a heterogenous entity requiring a number of different treatment strategies. Only 10-15% of patients with a symptomatic degenerative spondylolisthesis will require surgical intervention. The traditional surgical treatment has been decompression of the associated stenosis with a laminectomy and medial facetectomies. However, several studies have shown improved outcome with the addition of an intertransverse fusion. Although outcome is improved with fusion, a significant improvement in patient outcome has not been demonstrated with instrumented fusions. Thus, instrumented fusion should be reserved for patients at high risk for a progressive deformity such as patients with excessive motion on preoperative radiographs, a documented progressive slip, and those requiring a discectomy or total facetectomy to adequately decompress the neural elements. The standard type of fusion has been a posterolateral intertransverse fusion with autologous bone. An interbody fusion may be advantageous when there is severe disc space collapse with narrowing of the neuroforamen, when a discectomy is performed as part of the decompression, or to correct a kyphosis at that motion segment. Randomized, controlled outcome studies evaluating the use of instrumented fusions in subsets of patients with degenerative spondylolisthesis are needed. ObjectivesOn completion of this article the reader should understand the different treatment strategies for degenerative spondylolisthesis and the indications for each treatment.