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Spondylolisthesis : Summary

Indications for surgery

Age groupSpondylolisthesisIndications
PediatricLow gradeFailure to respond to conservative treatment (9-12 months)
Progressive slippage
Intractable low back or radicular pain
Neurological deficit and deterioration
High gradeNeurological symptoms
Severe sagittal plane spinal deformity
AdultLow gradeFailure of non-operative treatment
Progressive slippage
Symptomatic and radiographically unstable isthmic spondylolisthesis
High gradeDisabling back and/or low back pain
“Spondylolisthesis measurement on X-ray” by Source image: Chester J Donnally III Annotated by Mikael Häggström, M.D. Author info – Reusing images- Conflicts of interest: None Mikael Häggström, M.D. is licensed under CC BY 4.0.

SDSG classification

Mnemonic: SDSG
1. SDSG classification
2. Degree of slip
3. Spinopelvic balance
4. Global spinal balance

Degree of slipSpinopelvic balanceGlobal spinal balanceTypeRemarksSurgery
Low grade (Meyerding I and II)PI <45 (low PI)C7 plumb line falls over or behind femoral head (Balanced)1Nutcracker – clamping of posterior element of L5 between pars interarticularis of L4 and S1 during extensionInstrumentation and fusion
Postural reduction
PI 45-65 (normal PI)2
PI >65 (high PI)3Shear type –
High grade (Meyerding III, IV, V)SS > PT (Balanced)4
PT > SS (Unbalanced), i.e., retroverted pelvis5Reduction and realignment should be considered
PT > SS (Unbalanced), i.e., retroverted pelvisC7 plumb line falls anterior to femoral head (Unbalanced), i.e., stooping6Reduction and realignment are mandatory

Degenerative spondylolisthesis Instability Classification

ParameterType I, StableType II, Potentially unstableType III, Unstable
LBPNone or very mildPrimary or secondary symptomPrimary or secondary symptom
Restabilization signPresent
Grossly narrowed disc height
Some
Reduced disc height
None
Normal to slightly reduced disc height
Disc angleLordotic disc angles on flexion radiographs or <3 mm translation on dynamic filmsNeutral disc angle on flexion radiographs or 3-5 mm of translation on dynamic filmsKyphotic disc angle on flexion radiographs or >5 mm translation on dynamic films
Joint effusionNo facet joint effusion on MRIFacet joint effusion on MRI without distractionLarge facet joint effusion on MRI
SurgeryDecompression aloneDecompression and posterior fusionDecompression and posterior fusion and interbody fusion

General alignment targets

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