Lumbar spondylolisthesis is a very common condition in the population above 50, which often results in spinal stenosis accompanied by lower back pain and neurogenic claudication. If degenerative spondylolisthesis with spinal stenosis is symptomatic, surgical treatment is associated with a more favorable outcome than non-surgical treatment and should be the treatment of choice . In contrast to low grade spondylolisthesis the treatment of high grade spondylolisthesis (>50%) is controversial. The two surgical concepts of in situ fusion and realignment are still a matter of some debate. In situ fusion should be considered when sagittal balance is not impaired. Realignment should be the treatment of choice if sagittal imbalance has to be corrected, or in younger individuals where it should be prevented.
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