Neurosurgery

Spondylolisthesis

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Degenerative spondylolisthesis is a disease of the older adult that develops as a result of facet arthritis and facet remodeling. As the facets remodel, they take on a more sagittal orientation, allowing a mild slip to occur. These slips are very common: a study of osteoporosis found a 30% incidence among Caucasian women older than 65 years and a 60% incidence among African-American women older than 65 years. Most slips are asymptomatic but can worsen the symptoms of neurogenic claudication when associated with lumbar spinal stenosis. Degenerative spondylolisthesis with spinal stenosis is one of the most common indications for spine surgery among older adults, and current evidence suggests that patients have much better success rates and more clinical benefit with decompression and fusion than with decompression alone.

Traumatic spondylolisthesis is very rare and may be associated with acute fracture of the inferior facets or pars interarticularis. It is treated in the same manner as are other spinal fractures, and there are only a handful of case reports on this type.

Pathologic spondylolisthesis is the last type and is also very rare. This type can occur following damage to the posterior elements from metastases or metabolic bone disease. These slips have been reported in cases of Paget’s disease of bone, tuberculosis, giant-cell tumors, and tumor metastases.

Southern Tier Neuromedicine

Canandaguia/Finger Lakes Neurosurgery

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