Surgical Management of Degenerative and Postsurgical Spondylolisthesis

Following decompression, an arthrodesis is recommended for a degenerative spondylolisthesis since long-term studies have demonstrated improved outcomes. A postsurgical spondylolisthesis, by definition, is unstable and requires a concurrent stabilization. Surgical options include posterior pedicular rod and screw fixation, posteriorly placed interbody implants combined with pedicular instrumentation, or combined anterior and posterior procedures. Materials available for fusion include autograft, allograft, or new biologic graft substitutes such as rhBMP-2. This article reviews the etiology and pathogenesis of spondylolisthesis along with recommended treatment options and surgical techniques to enable clinicians to insure superior patient treatment outcomes.