CLINICAL ARTICLE

 

Degenerative spondylolisthesis: Part of the normal ageing process

 

 

Prof GJ Vlok

MBChB, MMed(Orth), FC(Orth)(SA). Professor and Head, Department of Orthopaedic Surgery, Tygerberg Hospital/University of Stellenbosch

Correspondence

 

 

---

ABSTRACT

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.

---

 

 

“Full text available only in PDF format”

 

 

References

1. Junghanns H. Spondylolisthesen ohne Spaltim Zwischergelenkstulcz (Pseudospondylisthen). Arch Orthop Unfallchir 1931;29:118-27.         [ Links ]

2. MacNab I. Spondylolisthesis with an intact neural arch: the so-called pseudo-spondylolisthesis. J Bone Joint Surg Br 1950;32:325-33.         [ Links ]

3. Newman PH. Spondylolisthesis: its cause and effect. Ann R Coll Surg Engl 1955;16:305-23.         [ Links ]

4. Rosenberg NJ. Degenerative spondylolisthesis: predisposing factors. J Bone Joint Surg Am 1975;57:467-74.         [ Links ]

5. Benoist M. The natural history of the aging spine. Eur Spine J Oct 2003, suppl. 2:586-9.         [ Links ]

6. Grobler LJ, Robertson PA, Novotny JE, Pope MH. Etiology of spondylolisthesis assessment of the role played by facet morphology. Spine 1993;18:80-91.         [ Links ]

7. Dilip K, Geugupta MD and Harry Herkowitz. Degenerative spondylolisthesis - Review of current trends and controversies. Spine 2005;30(65):571-81.         [ Links ]

8. Weinstein JN, Lurie JD, Tosteson TD, Hanscom B, Tosteson ANA, et al. Surgical versus non-surgical treatment of lumbar degenerative spondylolisthesis. N. England Journal of Med 2007;May 31:2257-70.         [ Links ]

9. Vibert BT, Sliva CD, Herkowitz HN. Treatment of instability and spondylolisthesis. Surgical versus non-surgical treatment. Clin Orthop and Related Research Febr 2006:222-7.         [ Links ]

10. Kristof RA, Aliashkevich AF, Schuster M, Meyer B, Urbach H, Schramm J. Degenerative lumbar spondylolisthesis-induced radicular compression: nonfusion-related decompression in selected patients without hypermobility on flexion-extension radiographs. Neurosurg 2002 Oct;97(3 Suppl):281-6.         [ Links ]

11. Majid K, Fishgrund JS. Degenerative lumbar spondylolisthesis: Trends in management. J AAOS 2008 April:208-15.         [ Links ]

12. Photos in figures 1a and 1b: A complimentary gift from Prof W Rausning, Upsula, Sweden.         [ Links ]

13. H Möller, R Hedlund. Instrumental and non-instrumental postero-lateral fusion in adult spondylolisthesis. Spine 2000;25:1716-21.         [ Links ]

14. Fishgrund JS, Mackay M, Herkowitz HN, Brower R, Montgomery DM, Kurz LT. Degenerative Spondylolisthesis with spinal stenosis: A prospective randomized study comparing decompressive laminect my and arthrodesis with and without spinal instrumentation. Spine 1997;22(24):2807-12.         [ Links ]

 

 

Correspondence:
Prof GJ Vlok
Tel: (021) 938-9266; Fax: (021) 931-5494
gjv@sun.ac.za