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Degenerative Spondylolisthesis : The preferable surgical technique

  • Komang Agung Irianto ,
  • Firman W. Hatmoko ,
  • Laskar P K ,


Introduction: Degenerative Spondylolisthesis is the major cause of low back pain, radiculopathy, and neurogenic claudication. The incidence rate for the general population ranged from 5% to 7%. Surgical method on degenerative spondylolisthesis is highly recommended. Objective: The purpose of this review is to determine the preferable surgical procedures for degenerative spondylolisthesis, which are still debatable.

Methods: A total of ffty relevant literatures were researched regarding degenerative spondylolisthesis, the diagnostic procedure, and the treatment from the period of 2007-2017. The author has chosen which surgical technique that is preferable between TLIF (Transforaminal
Lumbal Interbody Fusion) and PLF (Posterior Lumbal Fusion), from the so-called 50 literature journals.

Results and Discussion: The results showed that there was no signifcant difference regarding the back pain using Visual Analog Scale (VAS) during the preoperative procedure, in the operating level, the treatment duration, and the post-surgical complications between the two groups. There was also no signifcant difference in terms of leg pain (using VAS) between those two groups. On the other hand, the amount of blood loss, the duration of the surgery and successful fusion were signifcantly higher in the TLIF group than the PLF group.

Conclusion: When determining the surgical procedure, the author discovered the TLIF to be comparatively superior to the PLF regarding the fusion success, despite the longer surgical duration and higher amount of blood loss.


  1. Abdu WA, Lurie JD, Spratt KF, Tosteson ANA, Zhao W, Tosteson TD, Herkowitz H, Longely M, Boden SD, Emery S, Weinstein JN: Degenerative Spondylolisthesis : Does Fusion Method Influence Outcome? Four-Year Results of the Spine Patient Outcomes Research Trial. Spine 2009; 34(21): 2351–2360.
  2. Ahn K, Jhun HJ: New physical examination tests for lumbar spondylolisthesis and instability: low midline sill sign and interspinous gap change during lumbar flexion-extension motion.BMC Musculoskelet Disord 2015; 16 (97): 1471-2474.
  3. Arts M, Pondaag W, Peul, Thomeer R: Nerve root decompression without fusion in spondylolytic spondylolisthesis: long-term results of Gill’s procedure. Eur Spine J 2006; 15(10):1455-63.
  4. Backstrom KM, Whitman JM, Flynn TW: Lumbar spinal stenosis-diagnosis and management of the aging spine. Manual Therapy 2011; 16:308-317.
  5. Botelho RV, Foni NO, Gotfryd AO, Herrero CFPS, Daniel J, Meves R, Mudo ML, Simões RS, Zylbersztejn S, Bernardo WM: Degenerative spondylolisthesis: surgical treatment. Rev Assoc Med Bras 2014; 60(5): 400-403.
  6. Camara JR, Keen JR, Asgarzadie F: Functional Radiography in Examination of Spondylolisthesis. AJR 2015; 204: 461-469.
  7. Catana M, Gorgan M: Reduction and fusion in grade IV L5-S1 spondylolisthesis. Case presentation. Romanian Neurosurgery 201; 18(4): 546-550.
  8. Chaitanya M, Mittal A, Rallapalli R, Teja R, Prasad YS: Surgical Management of Spondylolisthesis by Pedicular Screw Rod System and Postero-Lateral Fusion. Open Journal of Orthopedics 2015; 5: 163-174.
  9. Cheung EV, Herman MJ, Cavalier R, Pizzutillo PD, MD: Spondylolysis and Spondylolisthesis in Children and Adolescents: II. Surgical Management. J Am Acad Orthop Surg 2006;14:488-498.
  10. Cloyd JM, Acosta FL, P. Ames CP: Complications and Outcomes of Lumbar Spine Surgery in Elderly People: A Review of the Literature. JAGS 2008 ;56(7):1318–1327.
  11. Cummins J, Lurie JD, Tosteson TD, Hanscom B, Abdu WA, Birkmeyer NJO, Herkowitz H, Weinstein J: Descriptive Epidemiology and Prior Healthcare Utilization of Patients in the Spine Patient Outcomes Research Trial’s (SPORT) Three Observational Cohorts. Spine 2006; 31(7): 806–814.
  12. Denard PJ, Holton KF, Miller J, Fink HA, Kado DM, Marshall LM, Yoo JU:Back Pain, Neurogenic Symptoms, and Physical Function in Relation to Spondylolisthesis among Elderly Men.Spine J 2010; 10(10): 865–873.
  13. Eismont. FJ, Norton RP, Hirsch BP: Surgical Management of Lumbar Degenerative Spondylolisthesis.J Am Acad Orthop Surg 2014; 22: 203-213.
  14. Esposito PW, Arlet V: Spinal Fractures, Spondylolysis and Spondylolysthesis. Elseiver 2014; 4: 409-419.
  15. Feldman DS, Straight JJ, Badra MI, Mohaideen A, Madan SS: Evaluation of an Algorithmic Approach to Pediatric Back Pain. J Pediatr Orthop2006;26:353-357.
  16. Fischer CR, Ducoffe AR, Errico TJ: Posterior Lumbar Fusion: Choice of Approach and Adjunct Techniques. J Am Acad Orthop Surg 2014; 22(8): 503-511.
  17. Francois J, Lauweryns P, Fabry G: Treatment of high-grade spondylolisthesis by posterior lumbosacral transfixation with transdiscal screws : Surgical technique and preliminary results in four cases. Acta Orthop. Belg 2005; 71: 334-341.
  18. Ghasemi AA:Transforaminal lumbar interbody fusion versus instrumented posterolateral fusion In degenerative spondylolisthesis: An attempt to evaluate the superiority of one method over the other. Clinical Neurology and Neurosurgery 2016;150: 1–5.
  19. Gillea O, ChallierV, Parent H, Cavagnac R, Poignardd A, Falinee A, Fuentes S, Ricart O, Ferrero E, Sliman MO: Degenerative lumbar spondylolisthesis. Cohort of 670 patients, and proposal of a new classification. Orthop Traumatol Surg Res 2014; 1027: 1-5.
  20. Haun DW, Kettner NW: Spondylolysis and spondylolisthesis: a narrative review of etiology, diagnosis, and conservative management. J Chiropr Med 2005; 4(4): 206–217.
  21. Hsieh CS, Lee HC, Oh HS, Park SJ, Hwang BW, Lee SH: Anterior lumbar interbody fusion with percutaneous pedicle screw fixation for multiple-level isthmic spondylolisthesis. Clinical Neurology and Neurosurgery; 158 (2017) 49–52.
  22. Hu SS, Tribus CB, Diab M, Ghanayem AJ: Spondylolisthesis and Spondylolysis. The Journal of Bone and Joint Surgery 2008; 90(3 ): 656-671.
  23. Jiang G, Ye C, Luo J, Chen W: Which is the optimum surgical strategy for spondylolisthesis: Reduction or fusion in situ? A meta-analysis from 12 comparative studies. International Journal of Surgery 2017; 42:128-13.
  24. Kalichman L, Hunter DJ: Diagnosis and conservative management of degenerative lumbar spondylolisthesis. Eur Spine J 2008; 17:327–335.
  25. Kalpakcioglua B, Altınbilekb T, Senelc K: Determination of spondylolisthesis in low back pain by clinical evaluation. Journal of Back and Musculoskeletal Rehabilitation 2009; 22: 27–32.
  26. Kasliwal MK, Smith JS, Kanter A, Chen CJ, Mummaneni PV, Hart RA, Shaffrey CI: Management of High-Grade Spondylolisthesis. Neurosurg Clin N Am 2013; 24: 275–291.
  27. Leonidou A, Lepetsos P, Pagkalos J, Antonis K, Flieger I, Tsiridis E,Leonidou O: Treatment for spondylolysis andspondylolisthesis in children. Journal of Orthopaedic Surgery 2015;23(3):379-82.
  28. Lim. CT, Hee HT, Liu G:Traumatic spondylolisthesis of the lumbar spine: a report of three cases.Journal of Orthopaedic Surgery 2009; 17(3): 361-365.
  29. Liu X, Wang L, Yuan S, Tian Y, Zheng Y, Li J: Multiple-level lumbar spondylolysis and spondylolisthesis. J Neurosurg Spine 2015; 22: 283–287.
  30. Longo UG, Loppini M, Romeo G, Maffulli N, Denaro V: Evidence-Based Surgical Management of Spondylolisthesis: Reduction or Arthrodesis in Situ.J Bone Joint Surg Am 2014; 96: 53-8.
  31. Majid K, Fischgrund JS. Degenerative Lumbar Spondylolisthesis: Trends in Management. J Am Acad Orthop Surg 2008;16:208-215.
  32. Manchikanti L et al. An Update of Comprehensive Evidence-Based Guidelines for Interventional Techniques in Chronic Spinal Pain. Part II: Guidance and Recommendations. Pain Physician 2013; 16:S49-S283.
  33. Mashaly H, Paschel EE, Khattar NK,Goldschmidt E, Gerszten PC : Posterior lumbar dynamic stabilization instead of arthrodesis for symptomatic adjacent-segment degenerative stenosis: description of a novel technique. Neurosurg Focus 2016; 40 (1):E5.
  34. Metzger R, Chaney S: Spondylolysis and spondylolisthesis: What the primary care provider should know. Journal of the American Association of Nurse Practitioners 2014; 26: 5–12.
  35. Mobbs RJ, Phan K, Malham G, Seex K, Ra PJ: Lumbar interbody fusion: techniques, indications and comparisonof interbody fusion options including PLIF, TLIF, MI-TLIF, OLIF/ATP, LLIF and ALIF. J Spine Surg 2015;1(1):2-18
  36. Mobbs RJ, Sivabalan P, Li J: Technique, challenges and indications for percutaneous pedicle screw fixation. Journal of Clinical Neuroscience 2017;18:741–749.
  37. Moller H, Sundin A, Hedlund R: Symptoms, Signs, and Functional Disability in Adult Spondylolisthesis. Spine 2000; 25 (6): 683–689.
  38. Motley G, Nyland J, Jacobs J, Caborn DNM: The Pars Interarticularis Stress Reaction, Spondylolysis, and Spondylolisthesis Progression. Jounal of Athletic Training 1998;33(4):351-358.
  39. Nau E, Hanney WJ, Kolber MJ: Spinal Conditioning for Athletes With Lumbar Spondylolysis and Spondylolisthesis. National Strength and Conditioning Association 2008; 30 (2): 43-52.
  40. Pasha IF, Qureshi MA, Haider IZ, Malik AS, Tahir UB: Surgical Treatment In Lumbar Spondylolisthesis : Experience With 45 Patients.J Ayub Med Coll Abbottabad 2012;24(1): 75-78.
  41. Passias PG, Poorman CE, Yang S, Boniello AJ, Jalai CM, Worley N, Lafage V: Surgical Treatment Strategies for High-Grade Spondylolisthesis: A Systematic Review.International Journal of Spine Surgery 2015; 9 (50): 1-21.
  42. Rihn JA, Hilibrand AS, Zhao W, Lurie JD, Vaccaro AR, Albert TJ, Weinstein J: Effectiveness of Surgery for Lumbar Stenosis and Degenerative Spondylolisthesis in the Octogenarian Population. J Bone Joint Surg Am. 2015;97:177-85.
  43. Roussouly P, Meyrat RB: High-Grade Spondylolisthesis: Partial Reduction. Spinal Surgery; 6(65): 638-645.
  44. Ruf M, Koch H, Melcher RP, Harms J: Anatomic Reduction and Monosegmental Fusion in High-Grade Developmental Spondylolisthesis. Spine 2006; 31(3): 269–274.
  45. Sadiq S, Meir A, Hughes SPF:Surgical management of spondylolisthesis overview of literature. Neurology India 2005;53(4):506-511.
  46. Sedney CL, McConda DB, Daffner SD: Natural history of spondylolysis and spondylolisthesis.Semin Spine Surg2014; 26: 214-218.
  47. Simmonds AM, Rampersaud YR, Dvorak MF, Dea N, Melnyk AD, Fisher CG: Defining the inherent stability of degenerative spondylolisthesis: a systematic review. J Neurosurg Spine 23:178–189, 2015
  48. Serhan H, Mhatre D, Defossez H, Bono CM. Motion-preserving technologies for degenerative lumbar spine: The past, present, and future horizons. SAS Journal 2011;5:75–89.
  49. Tebet MA: Current concepts on the sagittal balance and classification ofspondylolysis and spondylolisthesis.Rev bras ortop 2014;49(1):3–12.
  50. Wang YXJ, Ka´pla´r Z, Deng M, Leung JCS: Lumbar degenerative spondylolisthesis epidemiology: A systematic review with a focus on gender-specific and age-specific prevalence. Journal of Orthopaedic Translation 2017; 11: 39-52.

How to Cite

Irianto, K. A., Hatmoko, F. W., & K, L. P. (2018). Degenerative Spondylolisthesis : The preferable surgical technique. Bali Medical Journal, 7(1), 215–219.




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