The spine is made up of vertebrae that are stacked on top of each other. In lumbar spondylolisthesis, a vertebra in the lower back slides forward.
Treatment for spondylolisthesis
Spinal fusion technology, instrumented stabilization and reduction methods are innovative treatment options for spondylolisthesis.
It is worth mentioning that good results have been reported with minimal complications after transpedicular reduction and fusion without decompression in patients with unstable degenerative spondylolisthesis. Specialists have achieved this without evidence of associated degenerative stenosis. Spinal stenosis refers to the narrowing of the spinal canal, compressing the nerves travelling through the lower back into the legs.
About neural compression
Neural compression (caused by direct pressure on a nerve) in degenerative spondylolisthesis is usually the result of osteophytic hypertrophy (bone spurs) of the superior facet of the inferior vertebra.
As a consequence, repositioning of the slipped vertebra risks neural compression between the inferior end plate of the slipped vertebra and the hypertrophic superior facet of the adjacent caudal vertebrae, especially if prior decompression is not performed.
Lumbar decompression surgery is a type of surgery used to treat compressed nerves in the lumbar spine.
As most patients with degenerative spondylolisthesis have low-grade slips, an attempt at an aggressive reduction is usually not warranted. It does not treat the cause of the patient’s symptoms and is not risk free such as an increased failure rate by pull-out of the pedicle screws particularly in osteoporotic bone. Besides, the reduced spondylolisthesis tends to revert to its original position.
Our conclusion is that there is no need to reduce a degenerative spondylolisthesis during surgery as long as the nerve compression is released adequately and the spine stabilised.
You might also want to read: Degenerative Spondylolisthesis
At Harley Street Hospital, we have some of the best specialists to diagnose and treat spondylolisthesis. Book an appointment to get a checkup.