Evidence-Based Medicine for the Spine: Degenerative Spondylolisthesis

Degenerative spondylolisthesis is an important disorder of the aging spine, and has a significant effect on health-related quality of life in symptomatic adults. The management of degenerative spondylolisthesis is characterized by significant variability in nonoperative and operative approaches to care. The important questions and controversies in degenerative spondylolisthesis include the role of operative and nonoperative care. Within the realm of operative care, controversies include the role of decompression alone compared with decompression and fusion, the role of instrumentation in arthrodesis surgery, and the role of circumferential surgery compared with a posterolateral approach. The place of surgery for degenerative spondylolisthesis in a value-based healthcare economy is an important controversy that will determine whether allocation of limited healthcare resources to surgical care of this common disorder in the aging population is warranted compared with other demands on the healthcare economy. The objective of this paper is to review the most important literature to address these controversies.