Abstract
Degenerative spondylolisthesis associated with spinal stenosis is a common problem in elderly patients. It is most often seen at the L4-5 level. Back pain is the most common complaint, but neurogenic claudication is the most frequent clinical sequela associated with a diminished quality of life. First line treatment of degenerative spondylolisthesis consists of conservative nonoperative modalities. Patients who are surgical candidates are those who have neurological deficits: cauda equina, progressive weakness, pain or neuroclaudication. Surgical intervention ranges from decompression alone to decompression and 360° fusion with instrumentation. Current prospective trials have evaluated the use of bone substitutes as alternatives for autogenous bone graft. New motion sparing devices have been advocated as an alternative to fusion. Physicians should critically evaluate these newer technologies and exercise caution regarding their use both in efficacy and safety until the time that prospective trials have been completed.
Degenerative spondylolisthesis is the displacement of one vertebral body on another adjacent vertebral body with an intact neural arch [1]. Newman [2] was the first to use the term “degenerative spondylolisthesis” in the literature in 1955. He also described the degenerative arthritic changes involved in the facets at the level of disease. The clinical presentation of degenerative spondylolisthesis is varied and has been classified into such categories as spondylolisthesis, spinal stenosis, and segmental instability. To best treat a patient with degenerative spondylolisthesis one must understand the epidemiology, diagnostic tools and criteria, and surgical as well as non-surgical options to manage this disease process.
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References
Junghanns H (1931) Spondylolisthesen ohne Spaltim Zwischergelenkstules (Psedospondylisthen). Arch Orthop Unfallchir 29: 118–127
Newman PH (1955) Spondylolisthesis, its cause and effect. Ann R Coll Surg Engl 16: 305–323
Cauchoix J, Benoist M, Chassaing V (1976) Degenerative spondylolisthesis, its cause and effect. Clin Orthop Relat Res 115: 122–129
Rosenberg NJ (1975) Degenerative spondylolisthesis: Predisposing factors. J Bone Joint Surg Am 57: 467–474
Ha KY, Chang CH, Kim KW, Kim YS, Na KH, Lee JS (2005) Expression of estrogen receptor of the facet joints in degenerative spondylolisthesis. Spine 30: 562–566
Labelle H, et al (2004) Spondylolisthesis, pelvic incidence, and spinopelvic balance: a correlation study. Spine 29: 18; 2049–2054
Matsunaga S, Ijiri K, Hayahi K (2000) Nonsurgically managed patients with degenerative spondylolisthesis: a 10-to 18-year follow-up study. J Neurosurg 93: 194–198
Love TW, Fagan AB, Fraser RD (1999) Degenerative spondylolisthesis: developmental or acquired? J Bone Joint Surg Br 81: 670–674
Grobler LJ, Robertson PA, Novotny JE, Pope MH (1993) Etiology of spondylolisthesis: assessment of the role played by lumbar facet morphology. Spine 18: 80–91
Vakenberg HA, Haanen HCM (1982) The epidemiology of low back pain, in White AA III, Gordon SL (eds): American Academy of Orthopaedic Surgeons Symposium on Idiopathic Low Back Pain. St Louis: CV Mosby, pp 9–22
Frymoyer JW (1994) Degenerative Spondylolisthesis: Diagnosis and Treatment. J Am Acad Orthop Surg 2: 9–15
Vibert BT, Sliva CD, Herkowitz HN (2006) Treatment of instability and spondylolisthesis: surgical versus nonsurgical treatment. Clin Orthop Relat Res 443: 222–227
LaBan MM, Viola SL, Femminineo AF, et al (1990) Restless legs syndrome associated with diminished cardiopulmonary compliance and lumbar spinal stenosis: a motor concomitant of “vespers curse.” Arch Phys Med Rehabil 71: 384–388
Frymoyer JW (1992) Degenerative spondylolisthesis, in Andersson GBJ, McNeill TW (eds): Lumbar Spinal Stenosis. St Louis, Mosby Year Book
Kostuik JP, Harrington I, Alexander D, et al (1986) Cauda equina syndrome and lumbar disc herniation. J Bone Joint Surg Am 68: 386–391
Vad VB, Bhat AL, Lutz GE, Cammisa F (2002) Transforaminal epidural steroid injections in lumbosacral radiculopathy. Spine 27: 11–16
Buenaventura RM, Datta S, Abdi S, Smith H (2009) Systemic review of therapeutic lumbar transforaminal epidural steroid injections. Pain Phys 12: 233–251
Anderson PA, Tribus CB, Kitchel SH (2006) Treatment of neurogenic claudication by interspinous decompression: application of the X STOP device in patients with lumbar degenerative spondylolisthesis. J Neurosurg Spine 4: 463–471
Weinstein JN, Lurie JD, Tosteson TD, et al (2007) Surgical versus nonsurgical treatment for lumbar degenerative spondylolisthesis. N Engl J Med 356: 2257–2270
Weinstein JN, Lurie JD, Tosteson TD, et al (2009) Surgical compared with nonoperative treatment for lumbar degenerative spondylolisthesis. Four-year results in the Spine Patient Outcomes Research Trial (SPORT) randomized and observational cohorts. J Bone Joint Surg Am 91: 1295–1304
Herkowitz HN, Kurz LT (1991) Degenerative lumbar spondylolisthesis with spinal stenosis: a prospective study comparing decompression with decompression and intertransverse process arthrodesis. J Bone Joint Surg Am 73: 802–808
Fischgrund JS, Mackay M, Herkowitz HN, Brower R, Montgomery DM, Kurz LT (1997) 1997 Volvo Award winner in clinical studies. Degenerative lumbar spondylolisthesis with spinal stenosis. A prospective, randomized study comparing decompressive laminectomy and arthrodesis with and without spinal instrumentation. Spine 22: 2807–2812
Ghogawala Z, Benzel EC, Amin-Hanjani S et al (2004) Prospective outcomes evaluation after decompression with or without instrumented fusion for lumbar stenosis and degenerative grade I spondylolisthesis. J Neurosurg Spine 1: 267–272
Kornblum MB, Fischgrund JS, Herkowitz HN, Abraham DA, Berkower DL, Ditkoff JS (2004) Degenerative lumbar spondylolisthesis with spinal stenosis: a prospective long-term study comparing fusion and pseudoarthrosis. Spine 29: 726–734
La Rosa G, Conti A, Cacciola F et al (2003) Pedicle screw fixation for isthmic spondylolisthesis: Does posterior lumbar interbody fusion improve outcome over posterolateral fusion? J neurosurg 99(2 suppl): 143–150
Abdu WA, Lurie JD, Spratt KF et al (2009) Degenerative spondylolisthesis: does fusion method influence outcome? Four-year results of the Spine Patient Outcomes Research Trial. Spine 34: 2351–2360
Pearson, A, Blood E, Lurie J et al (2010) Predominant leg pain is associated with better surgical outcomes in degenerative spondylolisthesis and spinal stenosis: Results from the Spine Patient Outcomes Research Trial (SPORT). Spine (Phila PA 1976) [In press]
Tosteson A, Lurie JD, Tosteson TD, et al (2008) Surgical treatment of spinal stenosis with and without degenerative spondylolisthesis: Cost-effectiveness after 2 years. Ann Intern Med 149: 845–853
Ito Z, Matsuyama Y, Sakai Y, et al (2010) Bone union rate with autologous iliac bone versus local bone graft in posterior lumbar interbody fusion. Spine 33: E1101–1105
Boden SD, Kang J, Sandhu H, Heller JG (2002) 2002 Volvo Award in clinical studies. Use of recombinant human bone morphogenetic protein-2 to achieve posterolateral lumbar spine fusion in humans: a prospective, randomized clinical pilot trial. Spine 27: 2662–2673
Mulconrey DS, Bridwell KH, Flynn J, et al (2008) Bone morphogenetic protein (rhBMP-2) as a substitute for iliac crest bone graft in multilevel adult spinal deformity surgery. Spine 33: 2153–2159
Carreon LY, Glassman SD, Djurasovic M, et al (2009) RhBMP-2 versus iliac crest bone graft for lumbar spine fusion in patients over 60 years of age. Spine 34: 238–243
Postacchini F, Cinotti G (1992) Bone regrowth after surgical decompression for lumbar spinal stenosis. J Bone Joint Surg Br 74: 862–869
Konno S, Kikuchi S (2000) Prospective study of surgical treatment of degenerative spondylolisthesis: comparison between decompression alone and decompression with Graf system stabilization. Spine 25: 1533–1537
Schnake KJ, Schaeren S, Jeanneret B (2006) Dynamic stabilization in addition to decompression for lumbar spinal stenosis with degenerative spondylolisthesis. Spine 31: 442–449
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Dr. Harry N. Herkowitz is the Chairman and Director of the Department of Or thopaedic Surgery at William Beaumont Hospital in Royal Oak, Michigan. Dr. Herkowitz earned his Medical degree at Wayne State University School of Medicine. He had both an Internship and a Residency in Orthopaedic Surgery at William Beaumont Hospital. He was a Spine Surgery Fellow under the direction of Richard H. Rothman, M.D., Ph.D., and Frederick A. Simeone, M.D., at Pennsylvania Hospital.
As an active member of many professional societies, Dr. Herkowitz has often served as officer and committee member. He is the President of the American Board of Orthopaedic Surgery. He was President of the Spine Journal in 1998 and 1999. He is currently the Director of the Research Council for the North American Spine Society as well as on their Executive Board. Additionally, he is a member of the American Academy of Orthopaedic Surgeons, American Orthopaedic Association, International Society for the Study of the Lumbar Spine, Association of Bone and Joint Surgeons, and the Academic Orthopedic Society.
Dr. Herkowitz has contributed to the published research of orthopaedic and spine issues as Editor of four medical texts, written 36 chapters, 39 refereed journal articles and 33 non-refereed journal articles. Dr. Herkowitz is on the Editorial Board of many professional journals including: the Journal of Spinal Disorders, Spine, Operative Techniques in Orthopaedics, Advances in Orthopaedic Surgery, Clinical Orthopaedics and Related Research, and Cervical Spine Research Society. Dr. Herkowitz is two-time recipient of the Volvo Award for Clinical Research in Low Back Pain.
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Winters, J.M., Herkowitz, H.N. Degenerative lumbar spondylolisthesis: evolution of treatment. ArgoSpine News J 23, 3–9 (2011). https://doi.org/10.1007/s12240-011-0002-1
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DOI: https://doi.org/10.1007/s12240-011-0002-1