Natural History of Lumbar Spondylolisthesis

The natural history of spondylolisthesis remains inadequately understood, and an optimal treatment algorithm has not yet been clearly established. A better understanding of the natural history is crucial for guiding surgical decision-making. In this article, we aimed to characterize the natural course of spondylolisthesis, focusing on slip progression and destabilization risk. Analysis of the natural history of both degenerative and isthmic spondylolisthesis based on radiographic parameters and prospective studies indicates that slip progression occurs in approximately one-third of patients over long-term follow-up. Surgical decision-making should be informed by examining whether or not the degree of spondylolisthesis has progressed whenever possible.