Guideline summary review: an evidence-based clinical guideline for the diagnosis and treatment of adult isthmic spondylolisthesis.
The North American Spine Society's (NASS) Evidence-Based Clinical Guideline for the Diagnosis and Treatment of Adult Isthmic Spondylolisthesis features evidence-based recommendations for diagnosing and treating adult patients with isthmic spondylolisthesis. The guideline is intended to reflect contemporary treatment concepts for symptomatic isthmic spondylolisthesis as reflected in the highest quality clinical literature available on this subject as of June 2013. NASS' guideline on this topic is the only guideline on adult isthmic spondylolisthesis accepted in the Agency for Healthcare Research and Quality's National Guideline Clearinghouse.



The purpose of the guideline is to provide an evidence-based educational tool to assist spine specialists when making clinical decisions for adult patients with isthmic spondylolisthesis. This article provides a brief summary of the evidence-based guideline recommendations for diagnosing and treating patients with this condition.



This is a guideline summary review.



This guideline is the product of the Adult Isthmic Spondylolisthesis Work Group of NASS' Evidence-Based Clinical Guideline Development Committee. The methods used to develop this guideline are detailed in the complete guideline and technical report available on the NASS website. In brief, a multidisciplinary work group of spine care specialists convened to identify clinical questionsto address in the guideline. The literature search strategy was developed in consultation with medical librarians. Upon completion of the systematic literature search, evidence relevant to the clinical questions posed in the guideline was reviewed. Work group members utilized NASS evidentiary table templates to summarize study conclusions, identify study strengths and weaknesses, and assign levels of evidence. Work group members participated in webcasts and in-person recommendation meetings to update and formulate evidence-based recommendations and incorporate expert opinion when necessary. The draft guidelines were submitted to an internal peer review process and ultimately approved by the NASS Board of Directors. Upon publication, the Adult Isthmic Spondylolisthesis guideline was accepted into the National Guideline Clearinghouse and will be updated approximately every 5 years.



Thirty-one clinical questions were addressed, and the answers are summarized in this article. The respective recommendations were graded according to the levels of evidence of the supporting literature.



The evidence-based clinical guideline has been created using techniques of evidence-based medicine and best available evidence to aid practitioners in the diagnosis and treatment of adult patients with isthmic spondylolisthesis. The entire guideline document, including the evidentiary tables, literature search parameters, literature attrition flowchart, suggestions for future research, and all of the references, is available electronically on the NASS website at https://www.spine.org/ResearchClinicalCare/QualityImprovement/ClinicalGuidelines.aspx and will remain updated on a timely schedule.
Ahwatukee Sports & Spine, 4530 E. Muirwood Dr, Ste. 110, Phoenix, AZ 85048-7693, USA. Electronic address: skreiner@ahwatukeesportsandspine.com.
D Scott
DS
Kreiner
Department of Neurosurgery, Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI 53226, USA.
Jamie
J
Baisden
Cleveland Clinic Center for Spine Health, 9500 Euclid Ave, Cleveland, OH 44195, USA.
Daniel J
DJ
Mazanec
University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48109, USA.
Rakesh D
RD
Patel
Department of Orthopedic Surgery, New York University School of Medicine, 550 1st Avenue, New York, NY 10016, USA.
Robert S
RS
Bess
University of Kansas Medical Center, 3901 Rainbow Blvd # 5013, Kansas City, KS 66103, USA.
Douglas
D
Burton
The CORE Institute, 18444 N 25th Ave, Phoenix, AZ 85023, USA.
Norman B
NB
Chutkan
Neurological Monitoring Associates, LLC, 333 W Brown Deer Rd, Milwaukee, WI 53217, USA.
Bernard A
BA
Cohen
Norton Leatherman Spine Center, Department of Orthopaedic Surgery, University of Louisville, 210 E Gray St, Louisville, KY 40202, USA.
Charles H
CH
Crawford
Denver Spine, 7800 E. Orchard Road, Greenwood Village, CO 80111, USA.
Gary
G
Ghiselli
Department of Neurological Surgery, University of Wisconsin, 20 S Park St, Madison, WI 53715, USA.
Amgad S
AS
Hanna
Department of Neurosurgery, Tufts Medical Center, 800 Washington St, Boston, MA 02111, USA.
Steven W
SW
Hwang
Department of Neurosurgery, Trakya University Faculty of Medicine, Edirne, Turkey 22030.
Cumhur
C
Kilincer
Center for Diagnostic Imaging, 5775 Wayzata Blvd, Saint Louis Park, MN 55416, USA.
Mark E
ME
Myers
Department of Neurosurgery, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48109, USA.
Paul
P
Park
North American Spine Society, 7075 Veterans Blvd, Willowbrook, IL 60527, USA.
Karie A
KA
Rosolowski
Spine and Pain Medicine, 655 Shrewsbury Ave, Shrewsbury, NJ 07702, USA.
Anil K
AK
Sharma
Cumberland Brain & Spine, 5655 Frist Blvd, Hermitage, TN 37076, USA.
Christopher K
CK
Taleghani
OrthoIndy, 8450 Northwest Blvd, Indianapolis, IN 46278, USA.
Terry R
TR
Trammell
Rockford Health Physicians, 2350 N Rockton Ave, Rockford, IL 61103, USA.
Andrew N
AN
Vo
Department of Orthopaedic Surgery, University of Tennessee-Campbell Clinic, 1400 S Germantown Rd, Germantown, TN 38138, USA.
Keith D
KD
Williams
D000328:Adult; D019317:Evidence-Based Medicine / Q000379:methods* / Q000592:standards; D006801:Humans; D009493:Neurosurgery / Q000458:organization & administration; D017410:Practice Guidelines as Topic; D012955:Societies, Medical; D013168:Spondylolisthesis / Q000175:diagnosis* / Q000628:therapy; D014481:United States
Adult spondylolisthesis; Clinical practice guideline; Clinical practice recommendations; Evidence-based guideline; Isthmic spondylolisthesis; Spondylolisthesis; Spondylolytic spondylolisthesis