How effective is surgical treatment for spondylolisthesis?

Generally speaking, surgical treatment of spondylolisthesis is relatively mature, so patients do not need to be too nervous or worried. Patients with spondylolisthesis must pay attention to care after treatment and avoid doing rough work so that their bodies can recover faster.

1. Degenerative spondylolisthesis

Degenerative slip is more common than other types of slip, and symptoms can usually be resolved with conservative treatment. However, surgery is beneficial for patients with severe and persistent low back pain and complications such as cauda equina syndrome and nerve root compression. The clinical investigation results of foreign scholars on degenerative slippage show that:

(1) 70% of leg pain is sciatica and 30% is intermittent claudication;

(2) 41% of myelograms were abnormal, and every patient with L4-L5 slip had compression of the L5 nerve root instead of the L4 nerve root;

(3) The slippage ranged from 2 to 13 mm, with an average of 4 mm;

(4) Age, preoperative slip degree, postoperative slip degree, and postoperative loss degree were not correlated with pain relief;

(5) Patients with increased protein levels in cerebrospinal fluid have a poor prognosis.

(6) Spondylolisthesis may still progress 2 years after surgery;

(7) In 76% of patients, the iliac crest line was lower than the L4-5 disc level. Degenerative spondylolisthesis is rarely > grade I, so reduction is usually not required. The purpose of surgery is mainly to relieve low back pain and relieve nerve compression. When the decompression range is large, pedicle screw system internal fixation plus bone grafting can be considered.

2. Treatment of spondylolysis in adults

The main goals of surgery for spondylolysis are to relieve pain and prevent progression of the slip. The surgical indications must be strictly followed. Some people have reported in the literature that local fixation and bone grafting of the isthmus of the vertebrae can be used to treat isthmic synostosis. Buck first used screw fixation plus local bone grafting, and Scott used steel wire wrapped around the transverse process to fix the spinous process. Xu Shaoting et al. in China also reported the method of local bone grafting. These methods have been rarely used since the widespread use of pedicle screws.