Adult isthmic spondylolisthesis

Area of Science:

• Orthopedics
• Neurosurgery
• Spinal Surgery

Background:

• Isthmic spondylolisthesis affects a small adult population, with similar low back pain incidence to the general population.
• Pars interarticularis defects and forward slip are unique pain generators in this condition.
• Neurologic symptoms can arise from nerve root impingement or degenerative changes associated with the deformity.

Purpose of the Study:

• To review the management of symptomatic isthmic spondylolisthesis.
• To evaluate the efficacy of surgical interventions for intractable pain or neurologic deficits.
• To compare different surgical techniques, including fusion methods.

Main Methods:

• Review of literature on isthmic spondylolisthesis management.
• Analysis of surgical outcomes, including success rates and complications.
• Comparison of decompression, posterolateral fusion, anterior lumbosacral interbody fusion, and circumferential fusion.

Main Results:

• Non-surgical management is effective for most symptomatic cases.
• Surgical intervention demonstrates >80% success in appropriately selected patients.
• Circumferential fusion shows improved fusion rates and potentially superior clinical outcomes compared to other methods.

Conclusions:

• Isthmic spondylolisthesis requires careful evaluation for pain generators and neurologic involvement.
• Surgical decompression and stabilization are beneficial for patients with intractable symptoms.
• Procedure selection should be based on radiographic, clinical findings, and risk-benefit analysis, with circumferential fusion offering advantages.