Surgery for Degenerative Spondylolisthesis

Surgery for Degenerative Spondylolisthesis

Surgery for a degenerative spondylolisthesis usually includes two parts, done together in one operation:

Decompression surgery (e.g. a laminectomy) alone is usually not advisable as the instability is still present and a subsequent fusion will be needed in up to 60% of patients. A 1991 randomized controlled study of fusion with and without pedicle screw instrumentation and found the fusion rates were much higher in the patients with instrumentation, but the clinical results were about the same1. However, when these same patients were followed up on 10 years later, the patients with a solid fusion ultimately fared significantly better than those that had not fused.

It is a difficult surgery to recover from as there is a lot of dissection. The hospital stay typically ranges from one to four days. It can take up to a year to fully recover. Usually, most patients can start most of their activities after the fusion has had three months to heal. Once the bone is fused, then the more active the patient is the stronger the bone will become.

Potential Benefits of the Surgery

Spinal fusion surgery for a degenerative spondylolisthesis is generally quite successful, with upwards of 90% of patients improving their function and enjoying a substantial decrease in their pain.

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Potential Risks and Complications

There are numerous risks and possible complications with surgery for degenerative spondylolisthesis and they are basically the same as for any fusion surgery. There are risks of non union (nonfusion, or arthrodesis), hardware failure, continued pain, adjacent segment degeneration, infection, bleeding, dural leak, nerve root damage and all the possible general anesthetic risks (e.g. blood clots, pulmonary emboli, pneumonia, heart attack or stroke). Most of these complications are rare, but increased risks can be seen in certain situations. Conditions that increase the risk of surgery include smoking (or any nicotine intake), obesity, multilevel fusions, osteoporosis (thinning of the bones), diabetes, rheumatoid arthritis, or prior failed back surgery.

Since degenerative spondylolisthesis is a condition that disproportionately affects individuals over age 60 or 65, the surgery does present some additional risk. Surgical risk is more directly related to the overall health of a patient and not his or her absolute age.

Particularly in patients who have multiple medical problems, surgery can be very risky. For some patients, even if non-surgical treatments have failed to alleviate their symptoms, surgery may present too much risk, and intermittent epidural injections combined with activity modification may be their best option.

After a fusion procedure, degeneration of the spinal segment adjacent to the fusion is possible. In an attempt to alleviate transferring extra stress to the next segment, there are many different devices currently being studied that hold the promise of being able to replace the function of the facet joint without having to include a fusion procedure. It is too early to determine whether or not the results of these newer technologies are better or worse than the standard fusion procedure. For more on this topic, see Posterior Motion Preservation Spine Surgery: Alternative to Spinal Fusion.

References:

  1. Herkowitz HN, Kurz LT, "Degenerative lumbar spondylolisthesis with spinal stenosis. A prospective study comparing decompression with decompression and intertransverse process arthrodesis," Journal of Bone and Joint Surgery Vol. 73 Issue 6 (Jul 1991):802-8.
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Article written by: Peter F. Ullrich, Jr., MD