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Adult Degenerative Spondylolisthesis

- Discussion:
    - often occurs as a result of degenerative disc disease and facet deficiency;
    - it is often associated w/ intersegmental instability and w/ central stenosis;
    - more commonly involves older black females and diabetics (affects females 6 times as much as males);
    - involves L4-L5 level four times more often than the L5/S1 level;
    - more common in pts w/ transitional L5 vertebrae;
    - degenerative spondylolisthesis often causes radiculopathy related to nerve compression within the foramen (ie, L4/L5 spondylithesis will cause a L4 radiculopathy);
          - nerve compression occurs between the superior end plate of the caudad vertebra and the inferior facet of the cephalad vertebrae;

- Radiographs:
    - x-rays are taken in the stading position to accentuate slippage;
    - in degenerative spondylolithesis, slippage rarely exceeds 35%;

- Non Operative Treatment:
    - indicated for patients who can be managed with NSAIDS, epidural steroids, bracing, and/or change of job type;
    - in upto 30% of patients, additional slippage may occur;

- Treatment:
    - decompression of the nerve roots & stabilization by posterolateral fusion;
    - in the study by Nork, et al (1999), 93% of patiets were satisfied with decompression and fusion (w/ instrumentation) for degenerative spondylolisthesis;
    - in the study by Herkowitz and Kruz (1991), 96% of patients had good to excellent results with decompression and fusion (w/o instrumentation)
           vs 44% of good to excellent results in patients with decompression alone;
           - in patients who underwent decompression alone, further slippage was often seen to occur

Degenerative lumbar spondylolisthesis with spinal stenosis. A prospective study comparing decompression with decompression and intertransverse process arthrodesis.

Year Book: Degenerative Spondylolisthesis with an Intact Neural Arch: A Review of 60 Cases With an Analysis of Clinical Findings and the Development of Surgical Management.

Spondylodesis augmented by transpedicular fixation in the treatment of olisthetic and degenerative conditions of the lumbar spine.

Degenerative spondylolisthesis.  Diagnosis and Treatment.

The role of fusion and instrumentation in the treatment of degenerative spondylolisthesis with spinal stenosis.

Treatment of degenerative spondylolisthesis.

Patient outcomes after decompression and instrumented posterior spinal fusion for degenerative spondylolisthesis.