, Volume 23, Issue 1, pp 3-9
Date: 20 Jul 2011

Degenerative lumbar spondylolisthesis: evolution of treatment

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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.

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.