Spondylolysis With or Without Spondylolisthesis

Abstract

Spondylolysis with or without spondylolisthesis is an often well-tolerated situation. However, growing or adult patients may experience severe back pain, referred pain or even neurological compromise that justifies surgical treatment. During growth, exceptionally in adult life, true instability with increase of the spondylolisthesis may also require stabilisation, in situ or after reduction of the deformity. Posterior, anterior and combined approaches intended to obtain correction and fusion have been described, the choice between available options remains difficult. The recent literature does not necessarily support procedures that seem more logical but are more invasive than others. While the importance of maintaining or restoring an adequate sagittal profile of the lumbar spine is universally well-accepted, the importance of slip correction is considered less important. This chapter intends to help the surgeon dealing with different situations encountered in spondylolysis and spondylolisthesis patients by first exposing the different techniques currently in use with their respective advantages and disadvantages and by considering the proper matching of the most logical procedure theoretically required by the anatomical situation and the functional expectations of the particular patient.