- Discussion:
- often occurs as a result of degenerative disc disease and facet deficiency;
- it is often associated w/ intersegmental instability and w/ central stenosis;
- more commonly involves older black females and diabetics (affects females 6 times as much as males);
- involves L4-L5 level four times more often than the L5/S1 level;
- more common in pts w/ transitional L5 vertebrae;
- degenerative spondylolisthesis often causes radiculopathy related to nerve compression within the foramen (ie, L4/L5 spondylithesis will cause a L4 radiculopathy);
- nerve compression occurs between the superior end plate of the caudad vertebra and the inferior facet of the cephalad vertebrae;
- Radiographs:
- x-rays are taken in the stading position to accentuate slippage;
- in degenerative spondylolithesis, slippage rarely exceeds 35%;
- Non Operative Treatment:
- indicated for patients who can be managed with NSAIDS, epidural steroids, bracing, and/or change of job type;
- in upto 30% of patients, additional slippage may occur;
- Treatment:
- decompression of the nerve roots & stabilization by posterolateral fusion;
- in the study by Nork, et al (1999), 93% of patiets were satisfied with decompression and fusion (w/ instrumentation) for degenerative spondylolisthesis;
- in the study by Herkowitz and Kruz (1991), 96% of patients had good to excellent results with decompression and fusion (w/o instrumentation)
vs 44% of good to excellent results in patients with decompression alone;
- in patients who underwent decompression alone, further slippage was often seen to occur
Degenerative lumbar spondylolisthesis with spinal stenosis. A prospective study comparing decompression with decompression and intertransverse process arthrodesis.
Degenerative spondylolisthesis. Diagnosis and Treatment.