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Seminars in Neurosurgery 2000; 11(2): 193-206
DOI: 10.1055/s-2000-13226
Copyright © 2000 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

DEGENERATIVE LUMBAR SPONDYLOLISTHESIS: TREATMENT STRATEGIES

Richard Stovall, Andrea Halliday
  • Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, TX; and Center for Neurological Disorders, P.A., Ft. Worth, Texas
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Publication History

Publication Date:
31 December 2000 (online)

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ABSTRACT

Degenerative lumbar spondylolisthesis is a heterogenous entity requiring a number of different treatment strategies. Only 10-15% of patients with a symptomatic degenerative spondylolisthesis will require surgical intervention. The traditional surgical treatment has been decompression of the associated stenosis with a laminectomy and medial facetectomies. However, several studies have shown improved outcome with the addition of an intertransverse fusion. Although outcome is improved with fusion, a significant improvement in patient outcome has not been demonstrated with instrumented fusions. Thus, instrumented fusion should be reserved for patients at high risk for a progressive deformity such as patients with excessive motion on preoperative radiographs, a documented progressive slip, and those requiring a discectomy or total facetectomy to adequately decompress the neural elements. The standard type of fusion has been a posterolateral intertransverse fusion with autologous bone. An interbody fusion may be advantageous when there is severe disc space collapse with narrowing of the neuroforamen, when a discectomy is performed as part of the decompression, or to correct a kyphosis at that motion segment. Randomized, controlled outcome studies evaluating the use of instrumented fusions in subsets of patients with degenerative spondylolisthesis are needed.

KEYWORD

Lumbar spondylolisthesis - lumbar stenosis - lumbar spine surgery

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