Degenerative spondylolisthesis. Its surgical management.

Little attention has been given to the amount of further slip and the success rate after decompression for degenerative spondylolisthesis. In this retrospective study, the answers to the following were sought: (1) Did decompression relieve symptoms; (2) Which decompressive technique was best; (3) Did further slip occur; (4) Did further slip make patients worse? Seventeen patients were available for an average 20-month follow-up. Six patients had a decompression laminectomy with facetectomies, and 11 had a decompression laminectomy with foraminotomies. None was fused. Patients rated their results as better or worse at follow-up. Nine were better, eight were worse. Five of six who had laminectomies with facetectomies were better. Only four of 11 who had laminectomies with foraminotomies were better. The average further slip was 3 mm. Further slip did not correlate with type of decompression, symptoms, and patients' subjective results. We recommended that a decompression laminectomy for degenerative spondylolisthesis include a facetectomy. Further study is necessary to evaluate the efficacy of a fusion in controlling chronic back pain in the postdecompressed patient with degenerative spondylolisthesis.