Degenerative lumbar spondylolisthesis: evolution of treatment
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 . Newman  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.
Keywordsdegenerative spondylolisthesis spinal stenosis segmental instability treatment Spine Patient Outcomes Research (SPORT) trial
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