Primary Versus Iatrogenic Spondylolisthesis: A Multi-Dimensional Comparison of Outcomes

Background: Spondylolisthesis is an important cause of lumbar and/or leg pain and can occur primarily or following spinal surgery. Our study aimed to compare the outcomes, patient satisfaction, and complications in patients surgically treated for primary versus iatrogenic spondylolisthesis. Methods: We included 90 patients who underwent spinal surgery for primary (group A, n = 46) and iatrogenic (group B, n = 44) spondylolisthesis. Radiographs were performed before and after spinal surgery. Low back pain and leg pain were assessed with the Visual Analog Scale preoperatively, postoperatively, and at 12 months, the Frankel classification was used to assess neurological impairment, and the Oswestry Disability Index was assessed preoperatively at 6 and 12 months. Results: Patients in group A had better surgical outcomes, with shorter surgical time (p = 0.005), less intraoperative bleeding (p = 0.0015), and achieving higher degrees of spondylolisthesis reduction (p = 0.0128) with more reduction distance reached (p = 0.0153). Moreover, patients from group A had significantly higher levels of low back pain preoperatively compared to patients from group B (p = 0.0042). No significant differences were noted in low back pain and leg pain at the 6- and 12-month follow-ups. Fewer implant failures were seen in group B, while group A had a slightly faster arthrodesis rate. Conclusions: Iatrogenic spondylolisthesis requires additional surgeries with increased risks and socioeconomic costs. However, while surgical challenges differ based on the etiology of spondylolisthesis, the long-term outcomes might not vary significantly. Future research is needed to address the optimization of surgical techniques and rehabilitation strategies in order to improve the outcomes in both cohorts.