Rationale for the surgical treatment of lumbar degenerative spondylolisthesis

Study Design. A questionnaire survey. Objective. The aim of this study was to determine the effect of patient age, dynamic instability, and/or low back pain on the treatment of patients with a degenerative spondylolisthesis, and if the operative approach is affected by surgeon specialty, location, or practice model. Summary of Background Data. The classic treatment for patients with symptomatic degenerative spondylolisthesis is decompression and fusion; however in a select group of patients, an isolated decompression may be reasonable. Methods. A survey was sent to surgeon members of the Lumbar Spine Research Society and AOSpine requesting information regarding their preferred treatment of degenerative spondylolisthesis for a number of different clinical scenarios. Determinants included patient age, the presence of instability, symptoms of low back pain, surgeon's location, surgeon's specialty, and practice model. Results. A total of 223 spine surgeons completed the survey. Age of the patient, the presence of instability, and low back pain all significantly (P<0.0001) affected the recommended treatment, which were independent of surgeon factors. Older patients were significantly less likely to be offered an interbody fusion and more likely to be recommended for an isolated decompression (P<0.0001), and the presence of dynamic instability made an interbody fusion more likely than an isolated decompression (P<0.0001). Of those who responded, 53.2% of surgeons reported they would recommend an isolated decompression for a properly selected patient with a degenerative spondylolisthesis. Conclusion. The most common operative treatment for a degenerative spondylolisthesis is a decompression and fusion; however, the results of this survey demonstrate that surgeons consider degenerative spondylolisthesis a heterogeneous condition that requires an individualized surgical plan. Future studies are needed to evaluate the effect of variables such as age, the presence of low back pain, and the presence of dynamic instability on patient reported outcomes from various surgical options.