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Results of Surgical Treatment of Adult Degenerative Spondylolisthesis

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Spondylolisthesis

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Abstract

The surgical treatment of adult degenerative spondylolisthesis continues to evolve. Although controversy still exists, there are several well-designed studies in recent years that have narrowed the debate on the preferred surgical treatment. Current surgical treatment strategies range from isolated nerve root decompression or a wider central decompression to decompression and fusion with or without instrumentation. While decompression alone may be appropriate in certain patient populations, decompression with fusion has demonstrated improved clinical outcomes in mid to long-term follow-up. However, there is no clear consensus regarding the best way to achieve solid fusion. Initial attempts utilizing a posterolateral fusion without instrumentation led to poor rates of arthrodesis. The advent of instrumentation has improved fusion rates by creating a more stable environment for arthrodesis to take place. Strategies to increase fusion rate tend to improve some outcomes, but it are not without increased risk to the patient. Current literature is focused tremendously on techniques to further improve stability. Anterior column support as well as techniques aimed at decreasing the morbidity associated with these procedures are receiving attention as are the debates to whether these measures improve patient outcomes. Orthobiologics (including bone morphogenetic protein) are being widely utilized to augment fusion, but the literature supporting their use has recently come into question. This chapter focuses on the current literature available in the surgical treatment of adult degenerative spondylolisthesis.

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Authors and Affiliations

  1. Department of Orthopaedics, William Beaumont Hospital, Royal Oak, Royal Oak, MI, USA

    Jad G. Khalil, Jannat Khan & Jeffrey S. Fischgrund

  2. Department of Orthopaedic Surgery, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA

    Theodore D. Koreckij

  3. St. Luke’s Hospital of Kansas City, Kansas City, MO, USA

    Theodore D. Koreckij

  4. Dickson-Diveley Midwest Orthopaedic Clinic, Kansas City, MO, USA

    Theodore D. Koreckij

  5. Kansas City Orthopaedic Institute, Leawood, KS, USA

    Theodore D. Koreckij

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  1. Stryker Spine, Brookfield, CT, USA

    Adam L. Wollowick

  2. Department of Orthopedic Surgery, Northwell Health, New Hyde Park, NY, USA

    Vishal Sarwahi

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Khalil, J.G., Khan, J., Koreckij, T.D., Fischgrund, J.S. (2023). Results of Surgical Treatment of Adult Degenerative Spondylolisthesis. In: Wollowick, A.L., Sarwahi, V. (eds) Spondylolisthesis. Springer, Cham. https://doi.org/10.1007/978-3-031-27253-0_26

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