Surgical Treatment
Do surgical treatments improve outcomes in the treatment of degenerative lumbar spondylolisthesis compared to the natural history of the disease?
Surgery is recommended for treatment of patients with symptomatic spinal stenosis associated with low grade degenerative spondylolisthesis whose symptoms have been recalcitrant to a trial of medical/interventional treatment.
Grade of Recommendation: B
Does surgical decompression alone improve surgical outcomes in the treatment of degenerative lumbar spondylolisthesis compared to medical/interventional treatment alone or the natural history of the disease?
Direct surgical decompression is recommended for treatment of patients with symptomatic spinal stenosis associated with low grade degenerative lumbar spondylolisthesis whose symptoms have been recalcitrant to a trial of medical/interventional treatment.
Grade of Recommendation: I (Insufficient Evidence)
Indirect surgical decompression is recommended for treatment of patients with symptomatic spinal stenosis associated with low grade degenerative lumbar spondylolisthesis whose symptoms have been recalcitrant to a trial of medical/interventional treatment.
Grade of Recommendation: I (Insufficient Evidence)
Does the addition of lumbar fusion, with or without instrumentation, to surgical decompression improve surgical outcomes in the treatment of degenerative lumbar spondylolisthesis compared to treatment by decompression alone?
Surgical decompression with fusion is recommended for the treatment of patients with symptomatic spinal stenosis and degenerative lumbar spondylolisthesis to improve clinical outcomes compared with decompression alone.
Grade of Recommendation: B
Does the addition of instrumentation to decompression and fusion for degenerative lumbar spondylolisthesis improve surgical outcomes compared with decompression and fusion alone?
The addition of instrumentation is recommended to improve fusion rates in patients with symptomatic spinal stenosis and degenerative lumbar spondylolisthesis.
Grade of Recommendation: B
The addition of instrumentation is not recommended to improve clinical outcomes for the treatment of patients with symptomatic spinal stenosis and degenerative lumbar spondylolisthesis.
Grade of Recommendation: B
How do outcomes of decompression with posterolateral fusion compare with those for 360° fusion in the treatment of degenerative lumbar spondylolisthesis?
Because of the paucity of literature addressing this question, the work group was unable to generate a recommendation to answer this question.
What is the role of reduction (deliberate attempt to reduce via surgical technique) with fusion in the treatment of degenerative lumbar spondylolisthesis?
Reduction with fusion and internal fixation of patients with low grade degenerative lumbar spondylolisthesis is not recommended to improve clinical outcomes.
Grade of Recommendation: I (Insufficient Evidence)
What is the long-term result (four+ years) of surgical management of degenerative lumbar spondylolisthesis?
Decompression and fusion is recommended as a means to provide satisfactory long-term results for the treatment of patients with symptomatic spinal stenosis and degenerative lumbar spondylolisthesis.
Grade of Recommendation: C