title: Surgery for adult spondylolisthesis: a systematic review of the evidence.
abstract: Surgery for isthmic and degenerative spondylolisthesis (SL) in adults is carried out very frequently in everyday practice. However, it is still unclear whether the results of surgery are better than those of conservative treatment and whether decompression alone or instrumented fusion with decompression should be recommended. In addition, the role of reduction is unclear. Four clinically relevant key questions were addressed in this study: (1) Is surgery more successful than conservative treatment in relation to pain and function in adult patients with isthmic SL? (2) Is surgery more successful than conservative treatment in relation to pain and function in adult patients with degenerative SL? (3) Is instrumented fusion with decompression more successful in relation to pain and function than decompression alone in adult patients with degenerative SL and spinal canal stenosis? (4) Is instrumented fusion with reduction more successful in relation to pain and function than instrumented fusion without reduction in adult patients with isthmic or degenerative SL? A systematic PubMed search was carried out to identify randomized and nonrandomized controlled trials on these topics. Papers were analyzed systematically in a search for the best evidence. A total of 18 studies was identified and analyzed: two for question 1, eight for question 2, four for question 3, and four for question 4. Surgery appears to be better than conservative treatment in adults with isthmic SL (poor evidence) and also in adults with degenerative SL (good evidence). Instrumented fusion with decompression appears to be more successful than decompression alone in adults with degenerative SL and spinal stenosis (poor evidence). Reduction and instrumented fusion does not appear to be more successful than instrumented fusion without reduction in adults with isthmic or degenerative SL (moderate evidence).
authors.affiliation: Department of Orthopaedics and Tumor Orthopaedics, Münster University Hospital, Albert-Schweitzer-Campus 1, 48149, Münster, Germany. dr.tobias.schulte@web.de.
authors.forename: Tobias L
authors.initials: TL
authors.lastname: Schulte
authors.affiliation: Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Ringel
authors.affiliation: Department of Spine Surgery and Scoliosis Center, Klinikum Neustadt, Neustadt i.H., Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Quante
authors.affiliation: Department of Neurosurgery, University of Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Sven O
authors.initials: SO
authors.lastname: Eicker
authors.affiliation: Association of the Scientific Medical Societies of Germany, AWMF, Marburg, Germany.
authors.forename: Cathleen
authors.initials: C
authors.lastname: Muche-Borowski
authors.affiliation: Clinic for Spinal Surgery, Schön Klinik Hamburg, Eilbek, Hamburg, Germany.
authors.forename: Ralph
authors.initials: R
authors.lastname: Kothe
mesh_terms: D000328:Adult; D001416:Back Pain; D000072700:Conservative Treatment; D019299:Decompression, Surgical / Q000379:methods*; D055317:Evidence-Based Practice; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery; D013123:Spinal Fusion / Q000379:methods*; D013130:Spinal Stenosis / Q000601:surgery*; D013168:Spondylolisthesis / Q000601:surgery*; D016896:Treatment Outcome
keywords: Adults; Conservative treatment; Decompression; Degenerative spondylolisthesis; Fusion; Isthmic spondylolisthesis; Reduction; Spondylolisthesis; Surgery