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Treatment for Degenerative Lumbar Spondylolisthesis: Current Concepts and New Evidence

  • Treatment of Lumbar Degenerative Pathology (HJ Kim and G Mundis, section editors)
  • Published:
Current Reviews in Musculoskeletal Medicine Aims and scope Submit manuscript

Abstract

Purpose of Review

Current guidelines for the optimal treatment degenerative spondylolisthesis are weak and based on limited high-quality evidence.

Recent Findings

There is some moderate evidence that decompression alone may be a feasible treatment with lower surgical morbidity and similar outcomes to fusion when performed in a select population with a low-grade slip. Similarly, addition of interbody fusion may be best suited to a subset of patients with high-grade degenerative spondylolisthesis, although this remains controversial. Minimally invasive techniques are increasingly being utilized for both decompression and fusion surgeries with more and more studies showing similar outcomes and lower postoperative morbidity for patients. This will likely be an area of continued intense research. Finally, the role of spondylolisthesis reduction will likely be determined as further investigation into optimal sagittal balance and spinopelvic parameters is conducted. Future identification of ideal thresholds for sagittal vertical axis and slip angle that will prevent progression and reoperation will play an important role in surgical treatment planning.

Summary

Current evidence supports surgical treatment of degenerative spondylolisthesis. While posterolateral spinal fusion remains the treatment of choice, the use of interbodies and decompressions without fusion may be efficacious in certain populations. However, additional high-quality evidence is needed, especially in newer areas of practice such as minimally invasive techniques and sagittal balance correction.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

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  1. Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    Andre M. Samuel & Matthew E. Cunningham

  2. Weill Cornell Medical College, 1300 York Avenue, New York, NY, 10065, USA

    Harold G. Moore & Matthew E. Cunningham

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Andre M. Samuel and Harold G. Moore declare that they have no conflict of interest. Matthew E. Cunningham reports grants from K2M and RTI, outside of the submitted work.

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This article is part of the Topical Collection on Treatment of Lumbar Degenerative Pathology

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Samuel, A.M., Moore, H.G. & Cunningham, M.E. Treatment for Degenerative Lumbar Spondylolisthesis: Current Concepts and New Evidence. Curr Rev Musculoskelet Med 10, 521–529 (2017). https://doi.org/10.1007/s12178-017-9442-3

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