Future Studies and Directions for the Optimization of Outcomes for Lumbar Spondylolisthesis.

Randomized prospective studies show clear benefits for operative versus nonoperative management of symptomatic lumbar spondylolisthesis, but there is no universally accepted surgical treatment. This article presents options for surgical management of lumbar spondylolisthesis, reviews the clinical trials delineating the role and type of surgical intervention, and explores the directions of future investigations. The next decade will add further clarity to the surgical management of spondylolisthesis, not by randomized prospective trials, but by surgical registries. The power of "big data" offered by registries will likely become the vehicle best suited to amass data on current and novel therapies.