Surgeons Offer Opinion on Treatment of Spondylolisthesis

In this review article surgeons from the William Beaumont Hospital in Michigan bring us up to date on spondylolisthesis. They discuss the causes, pathology, effects of, and treatment of this condition. They focus closely on recent changes in surgical treatment of spondylolisthesis.

Spondylolisthesis is a slipping of the spine. One vertebrae slips forward of the others. This may not seem like much of a problem but when the bone moves forward, pressure on the spinal cord and nerves increases. Serious problems can occur. Pain, weakness, numbness, and even paralysis can occur.

When conservative care fails, surgery should be considered. The authors review the various types of operations that can be done. Decompression or taking pressure off the spinal cord or spinal nerves was the first most common surgery. Part of the bone is removed called a laminectomy. The authors recommend using this treatment when there is spondylolisthesis with a stiff spinal segment.

Laminectomy with posterior fusion is the second type of surgery. No plates or screws called instrumentation are used. Bone graft holds the bones together. Based on the results of many studies, the authors say decompression with fusion and without instrumentation is a good treatment option.

The third type of surgery is a decompression with fusion using instrumentation. Plates and screws are used to hold the bone in place until bony fusion takes place. The idea is to get a more rigid spine for stability. The authors report most studies show that fusion rates are better with instrumentation.

Decompression with fusion from the front (anterior) and back (posterior) at the same time is gaining popularity as a surgical option. Increasing the fusion surface area gives better results. The newest change in this surgery is a move toward transforaminal lumbar interbody fusion (TLIF). TLIF fuses the anterior and posterior columns of the spine through a single posterior approach. Studies to compare this operation with the others are needed before this new method can be recommended.

Brady T. Vilbert, MD, et al. Treatment of Instability and Spondylolisthesis. In Clinical Orthopaedics and Related Research. February 2006. No. 443. Pp. 222-227.

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