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Abstract
The etiology of spondylolisthesis, which determines the pathoanatomy and natural course, includes the abnormal development of lumbosacrum and various acquired conditions. Many patients with symptomatic degenerative and isthmic spondylolisthesis respond to non-surgical treatments, such as modification of their daily activity, medication, physical therapy and nerve block. Surgical treatment is indicated for intractable pain, neurological symptoms and the progression of slip. The natural course and patient's demographics are also considered. Decompression of the neural stenosis and the fusion of segmental instability are the main surgical treatments of degenerative and isthmic spondylolisthesis Fusion and instrumentation should be chosen carefully for degenerative spondylolisthesis if it is stable. However, solid fusion is the most important procedure for isthmic spondylolisthesis. Anterior lumbar interbody fusion is an effective treatment regarding an anatomical restoration of slip, decompression of neural structures and optimal fusion for degenerative and isthmic spondylolisthesis.
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Table 1.
Classification by Wiltse et al
| Type | ||
|---|---|---|
| I | Dysplastic | A: facet with axial orientation |
| B: facet with sagittal orientation | ||
| II | Isthmic | A: lysis |
| B: elongation | ||
| C: fracture | ||
| III | Degenerative | |
| IV | Post-traumatic | |
| V | Pathologic | |
| VI | Postsurgical |
Table 2.
Marchetti and Bartolozzi classification
Table 3.
Conservative modalities for treatment of spondylolisthesis
Table 4.
Indication of fusion and instrumentation for degenerative spondylolisthesis
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