Evaluation and Treatment of Degenerative Lumbar Spondylolisthesis
Lumbar spondylolisthesis is a common cause of low back pain, with or without radiculopathy symptoms, that often worsens with activity or upright position. Degenerative spondylolisthesis is the most common of the multiple subtypes of spondylolisthesis. Radiographic screening and evaluation of spondylolisthesis should involve upright images, as well as dynamic flexion-extension films. This is because spondylolisthesis is often a dynamic condition, and can reduce to normal position on supine imaging studies such as MRI and CT, which may show normal alignment. When conservative approaches are no longer effective, surgical treatment for degenerative spondylolisthesis is effective and is associated with superior outcomes compared with nonoperative treatment. Decompression without fusion can be performed for mild degenerative spondylolisthesis without significant motion, although some studies show that the addition of fusion decreases the reoperation rate and has a small quality-of-life benefit. There is still debate regarding the addition of fusion to decompression for mild degenerative spondylolisthesis. If fusion is selected, there are multiple approaches, including a variety of interbody techniques.
