On-line version ISSN 2309-8309
SA orthop. j. vol.7 n.2 Pretoria Apr./Jun. 2008
Prof GJ Vlok
MBChB, MMed(Orth), FC(Orth)(SA). Professor and Head, Department of Orthopaedic Surgery, Tygerberg Hospital/University of Stellenbosch
Degenerative spondylolisthesis is a condition that occurs in the middle decades of a person's life and mainly affects the L4 and L5 level, especially in women. A good history, a clinical examination, well-planned special investigations and a definite diagnosis are mandatory. Various risk factors have been identified. A thorough investigation, a definite diagnosis and adequate conservative management remain the gold standard for treatment.
The majority of patients can be managed conservatively. Only about 10 to 15 per cent need surgery. Indications for surgery include severe mechanical backache with an unstable segment and radicular pain as well as progressive neurological deficit. Various forms of surgery and types of instrumentation are available, but the gold standard remains a posterior decompression, intertransverse fusion and pedicular instrumentation resulting in a solid intertransverse fusion. Other surgical modalities do exist, but they are associated with higher cost and morbidity. For some of these no long-term results are available.
Conservative treatment and decompressive surgery, where correctly indicated, and a solid fusion can increase a patient's quality of life considerably. Informed consent must be obtained and the patient must be informed that degeneration is an ongoing process. The same condition may recur at a higher level, in which case the surgery must not be regarded as a failure.
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Prof GJ Vlok
Tel: (021) 938-9266; Fax: (021) 931-5494