Degenerative Spondylolisthesis

Degenerative spondylolisthesis (DS) is characterized as the translation of a vertebral body over a subjacent vertebra that is associated with degenerative changes. DS may manifest as a variety of symptoms due to associated disc degeneration, facet arthrosis, instability, or spinal canal/foraminal stenosis. DS generally occurs in adults over 50 years old. The prevalence is reported as 5–8% and is more common in females compared to males. The most commonly affected level is the L4–5 level. The Meyerding grading system is the most widely utilized radiological classification system for DS. Recent studies support surgical intervention for DS patients with prolonged symptoms. There are multiple surgical options for DS, including fusion which is recommended for DS patients with gross instability. For stable DS, there has been inconsistent evidence about the optimal surgical technique. Decompression alone can be considered an option, especially for patients with multiple medical comorbidities or severe osteoporosis. Recent studies showed better results with fusion compared to decompression alone. If fusion is selected, the use of interbody fusion is recommended and there are multiple options available. In general, the reported outcomes are comparable among the various surgical treatments, but each procedure has specific advantages and unique complication profile that should be considered based on patient selection.