Surgery for adult spondylolisthesis: a systematic review of the evidence

Abstract

Surgery for isthmic and degenerative spondylolisthesis (SL) in adults is carried out very frequently in everyday practice. However, it is still unclear whether the results of surgery are better than those of conservative treatment and whether decompression alone or instrumented fusion with decompression should be recommended. In addition, the role of reduction is unclear. Four clinically relevant key questions were addressed in this study: (1) Is surgery more successful than conservative treatment in relation to pain and function in adult patients with isthmic SL? (2) Is surgery more successful than conservative treatment in relation to pain and function in adult patients with degenerative SL? (3) Is instrumented fusion with decompression more successful in relation to pain and function than decompression alone in adult patients with degenerative SL and spinal canal stenosis? (4) Is instrumented fusion with reduction more successful in relation to pain and function than instrumented fusion without reduction in adult patients with isthmic or degenerative SL? A systematic PubMed search was carried out to identify randomized and nonrandomized controlled trials on these topics. Papers were analyzed systematically in a search for the best evidence. A total of 18 studies was identified and analyzed: two for question 1, eight for question 2, four for question 3, and four for question 4. Surgery appears to be better than conservative treatment in adults with isthmic SL (poor evidence) and also in adults with degenerative SL (good evidence). Instrumented fusion with decompression appears to be more successful than decompression alone in adults with degenerative SL and spinal stenosis (poor evidence). Reduction and instrumented fusion does not appear to be more successful than instrumented fusion without reduction in adults with isthmic or degenerative SL (moderate evidence).

Minimally Invasive Transforaminal Lumbar Interbody Fusion: Comparison of Isthmic Versus Degenerative Spondylolisthesis

“…IS and DS most commonly present in healthy adolescents at L5-S1, and in elderly women at L4-L5, respectively. 1,3,4 The differences in age and location of spondylolisthesis observed between cohorts are therefore characteristic of their pathologic processes. Similarly, the age difference between cohorts explains the significant difference in comorbidity burden, as an increase in age is associated with increasing prevalence, number, and severity of comorbid conditions.…”

“…Several types of spondylolisthesis exist; however, the 2 most commonly observed forms are degenerative (DS) and isthmic (IS) spondylolisthesis ( Figure 1). 1 Occurring most often at L4-L5 in elderly females, DS is the result of intervertebral disc degeneration and arthritic changes to the facet joints resulting in segmental instability and subsequent anterolisthetic progression. This pathology commonly presents in the fourth and fifth decades of life.…”

“…This pathology commonly presents in the fourth and fifth decades of life. [1][2][3][4] In contrast, IS most commonly occurs in healthy adolescent and young adult athletes as the result of repetitive, hyperextension trauma to the posterior elements. This often results in an acquired bilateral defect, or spondylolysis, of the pars interarticularis at L5 and anterolisthetic progression of L5 over S1.…”

Evidenzbasierte Interventionen an der Lendenwirbelsäule

“…Obwohl die operative Therapie bei adulten Patienten mit isthmischer SO im Alltag relativ häufig ist, finden sich in einer aktuellen Evidenzanalyse einer Arbeitsgruppe der Deutschen Wirbelsäulengesellschaft (DWG) [150] sehr wenige hochwertige kontrollierte Studien, die zeigen, dass die operative Therapie bessere klinische Ergebnisse liefert als die konservative [151][152][153]. In seltenen Fällen kann bei adulten isthmischen SO mit bereits vorhandener Ankylose und ausschließlicher Radikulopathie eine isolierte Dekompression indiziert sein [136].…”

A novel noninstrumented surgical approach for foramen reconstruction for isthmic spondylolisthesis in patients with radiculopathy: preliminary clinical and radiographic outcomes

“…2,5,7,17 Recently, a systematic review concluded that instrumented fusion with decompression appeared to be more successful than decompression alone in the treatment of degenerative spondylolisthesis, albeit with poor evidence. 17 This conclusion, however, could not be confirmed by a robust randomized controlled trial. 5 Similarly, perhaps instrumented fusion techniques may not show the additional value in clinical outcomes over noninstrumented fusion techniques.…”