# Surgical and non-surgical management of spondylolisthesis: a comprehensive review

## TL;DR

This paper reviews the treatment options for spondylolisthesis, a spinal condition, focusing on both non-surgical and surgical approaches and their effectiveness.

## Contribution

The paper provides a comprehensive review of current and emerging treatment strategies for spondylolisthesis, emphasizing individualized and evidence-based care.

## Key findings

- Non-surgical treatments like physical therapy and pain management are effective for low-grade spondylolisthesis.
- Surgical options such as decompression and fusion are considered for severe cases or when conservative treatments fail.
- Minimally invasive surgical techniques are gaining popularity due to faster recovery and less tissue damage.

## Abstract

Spondylolisthesis is a spinal condition characterized by the forward or backward displacement of a vertebral body, most commonly affecting the lower lumbar spine. It can be classified into different types, with isthmic and degenerative being the most prevalent. Early diagnosis is essential to initiate appropriate treatment based on symptom severity, degree of slippage, and neurological deficits. Non-surgical management is the first-line approach for low-grade spondylolisthesis (Grade I-II) and includes physical therapy, activity modification, pain management with nonsteroidal anti-inflammatory drugs or epidural steroid injections, and, in some cases, bracing. While most patients experience symptom relief with conservative treatment, those with progressive neurological deficits, severe pain, or significant instability may require surgery. Surgical options typically include decompression for nerve compression and fusion to stabilize the spine. The choice between decompression alone and decompression with fusion remains controversial, particularly in degenerative spondylolisthesis without initial instability. Posterior lumbar interbody fusion and transforaminal lumbar interbody fusion are the most performed techniques, with minimally invasive surgery gaining popularity due to its less aggressive impact on tissues and faster recovery. Long-term follow-up is necessary to monitor for complications such as adjacent segment disease, pseudarthrosis, or reoperation rate. Advances in imaging, surgical navigation, and regenerative medicine are important for the future of spondylolisthesis treatment, but current management remains centered on optimizing patient outcomes through individualized care and evidence-based treatment selection.