TARGETING: SPINE SURGERY 

Journal of Neurosurgical Sciences 2013 June;57(2):103-13

Copyright © 2013 EDIZIONI MINERVA MEDICA

language: English

The current management of lumbar spondylolisthesis

Alfieri A. ¹, Gazzeri R. ², Prell J. ¹, Röllinghoff M. ³ ✉

¹ Department of Neurosurgery, Martin Luther University, Halle (Saale), Germany; ² Department of Neurosurgery, S. Giovanni, Rome, Italy; ³ Department of Orthopedic and Trauma Surgery, Martin Luther University, Halle (Saale), Germany

Lumbar spondylolisthesis can lead to disabling low back pain and neurological deficits. This review details the clinical history, neurological examination, clinical presentation, imaging modalities, and current management standards for lumbar spondylolisthesis. Based on the available clinical trials, there is evidence that, compared with nonsurgical care, the surgical treatment of symptomatic spondylolisthesis offers a significant clinical benefit in the presence of progressive neurological deficits; cauda equina syndrome; failure of an adequate response to conservative therapy: radiographic instability with neurological symptoms; radiographic progression of subluxation to greater than grade II; symptomatic grades III, II, or spondyloptosis; and unremitting pain that affects the quality of life. Optimizing the diagnostic paths and surgical indications and standardizing both the surgical procedures as well as the outcome measurements with validated instruments should assist the spine care community in acquiring data that are essential for providing the best evidence-based treatment while reducing or eliminating procedures that lack evidence of either efficacy or value.