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J Am Acad Orthop Surg, Vol 17, No 10, October 2009, 609-617.
© 2009 the American Academy of Orthopaedic Surgeons
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Adult Isthmic Spondylolisthesis

Thomas R. Jones, MD, PhD and Raj D. Rao, MD

Dr. Jones is Resident, Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI. Dr. Rao is Professor, Department of Orthopaedic Surgery, Medical College of Wisconsin.

Dr. Rao or a member of his immediate family serves as a board member, owner, officer, or committee member of the North American Spine Society and the Lumbar Spine Research Society. Neither Dr. Jones nor a member of his immediate family has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article.

Reprint requests: Dr. Rao, Department of Orthopaedic Surgery, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI 53226-0099.

Isthmic spondylolisthesis is present in a small subset of the adult population. Although the incidence of low back pain in these persons is similar to that of the general population, both pars interarticularis defect and forward slip can serve as unique pain generators. Neurologic symptoms may result from nerve root impingement related to the pars defect or degenerative changes associated with the deformity. Most symptomatic cases are successfully managed nonsurgically, but patients with intractable pain or neurologic symptoms may benefit from surgical decompression and stabilization. Surgical intervention has shown >80% success in appropriately selected patients, with a low incidence of complications. Surgical techniques include decompression, posterolateral fusion, anterior lumbosacral interbody fusion, and circumferential fusion methods. Circumferential fusion results in improved fusion rates and, in some studies, superior clinical outcomes. The choice of procedure is generally guided by the patient’s radiographic and clinical findings as well as risk-benefit considerations.






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Copyright © 2009 by the American Academy of Orthopaedic Surgeons.