Surgical management of adult spondylolysis and spondylolisthesis

The surgical management of spondylolisthesis depends on the type of spondylolisthesis, the grade of slip, and the clinical setting. The surgical approaches may broadly be divided into decompression alone, fusion alone, and a combination of decompression and fusion. Fusion options can be further subdivided into non-instrumented vs. instrumented, anterior vs. posterior, with or without interbody support, and/or combined approaches, often referred to as circumferential fusions. The indication for surgical treatment of spondylolysis is persistent, disabling back pain refractory to conservative management. In conclusion, an evidence-based approach combined with shared decision making with informed patients will lead to successful outcomes.