Welcome from Dwight Tyndall, MD, FAAOS
Lumbar spondylolisthesis, a forward slippage of one vertebral body over the one beneath, is a common spinal condition that affects children and adults. Often accompanying a spondylolisthesis is spondylolysis—a defect in the pars interarticularis. Although a L5-S1 spondylolisthesis is most common, it can occur in the levels above.
Proper diagnosis and treatment decision-making requires understanding the amount of listhesis, which may involve use of the Meyerding Classification system (Fig. 1), as well as other factors such as the patient’s age, level of symptoms, pars defect or not, including other lumbar pathology.
This issue of SpineScan focuses of various aspects of lumbar spondylolisthesis, including spondylolytic, dysplastic, degenerative, and isthmic. The journal articles featured in this issue examine the following points.
- Unlike adjacent segment disease associated with fusion, early adjacent disc degeneration is found on MRI of patients with spondylolytic spondylolisthesis who have not undergone spinal fusion.
- Nonoperative treatment had positive results in Grades 0, 1, 2. The authors noted poor patient compliance with exercise.
- Transforaminal epidural steroid injections demonstrated short- and long-term reduction in Roland 5-point and Visual Analogue Scores, and short-term improvement in standing and walking tolerances.
- Outcome studies (prospective randomized) of patients with degenerative lumbar spondylolisthesis are needed to determine what is driving surgical decision-making.
- Posterior lumbar interbody fusion with total facetectomy to treat low-dysplastic isthmic spondylolisthesis demonstrated good outcomes.
- The degenerative spondylolisthesis group was shown to have more anterior instability, a higher rate of fusion but less patient satisfaction.