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Surgical Treatment of Spondylolisthesys by Postero-lateral Arthrodesis and Instrumentation

February 01, 2014

Contributors: Francesco Turturro, MD; Cosma Calderaro, MD; Luca Labianca, MD; Vincenzo Di Sanzo, MD, PhD; Pierpaolo Rota, MD; Alessandro Carducci, MD; Andrea Ferretti, MD; Antonello Montanaro, MD; Antonello Montanaro, MD

Spondylolisthesis is the slipping of a vertebra relative to an adjacent vertebra on its caudal segment. Spondylolisthesis has been described using the classification system developed by Wiltse, which divides the condition into five types: dysplastic, isthmic, degenerative, posttraumatic, and pathologic. Marchetti and Bartolozzi developed a new classification system that distinguished developmental from acquired spondylolisthesis, and further divided developmental spondylolisthesis into low- and high-dysplastic. Back pain is the most frequent clinical presentation and can be associated with radicular pain. In most cases, nonsurgical treatment is successful in relieving pain; if not, or in cases of progression of slippage, surgery can be considered.

Surgical guidelines for spondylolisthesis are primarily based on slip grade, evidences of evolutive slippage, and radicular compression. For patients with moderate lumbar and/or radicular symptoms with a slip below 50% (grades I and II), the treatment of choice is the posterolateral instrumented arthrodesis. For patients with slippage exceeding 50% (grades III and IV) with significant lumbar radicular symptoms, the posterolateral instrumented arthrodesis with reduction of the spondylolisthesis associated or not with intersomatic posterior arthrodesis with cages or anterior release-arthrodesis is indicated. All of these procedures can include laminectomy to reduce pressure on nerve roots.

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