Adult low-grade acquired spondylolytic spondylolisthesis: evaluation and management.

Overview

STUDY DESIGN: Literature review. OBJECTIVE: To discuss the presentation and evaluation of adult patients with acquired spondylolytic spondylolisthesis of low-grade severity and to review surgical treatment options. SUMMARY OF BACKGROUND DATA: Low-grade adult acquired spondylolytic spondylolisthesis is one of the most common forms of spondylolisthesis. METHODS: Literature review. RESULTS: Adults with symptomatic low-grade spondylolytic spondylolisthesis are treated predominantly nonoperatively, with activity modification, physiotherapy, nonsteroidal anti-inflammatory agents, and local injections. Surgical treatment is reserved for individuals with intractable back pain and/or radicular symptoms. A number of surgical options exist, including direct pars repair, and fusion with or without decompression. Fusion can be achieved by providing anterior column support alone, posterior support alone, or a combined circumferential approach; the optimal method by which fusion should be achieved has not been established. CONCLUSIONS: The management of low-grade acquired spondylolytic spondylolisthesis requires a thoughtful and individualized approach, recognizing the frequently benign natural history of the deformity and the potentially good clinical outcomes from surgery in those select patients with intolerable back and leg pain. While fusion is the mainstay of surgical management, a prospective randomized study would be extremely useful to delineate the optimal fusion technique.