Overview of Clinical Assessment Principles of Treatment of Lumbar Spondylolithesis

Abstract

Lumbar spinal fusion is a common and effective surgical procedure for the treatment of degenerative lumbar diseases (DLD), such as spondylolisthesis, lumbar spinal canal stenosis associated with deformities, or discogenic pain identified by provocative discography. Careful history and physical examination are the first steps in the diagnosis of lumbar spondylolisthesis. The description of the pain is helpful and important in the diagnosis. The management of degenerative spondylolisthesis as spinal decompression with or without instrumented or noninstrumented spinal fusion. Evidence on the operative treatment of degenerative spondylolisthesis is still divisive. The goal of lumbar fusion surgery is to regain a solid arthrodesis of spinal segments while restoring disk height, immobilizing the unstable segment, and restoring load bearing to anterior structures. Traditionally, bilateral PSF is considered as a widely accepted method for the treatment of a variety of spinal diseases to provide both biomechanical and clinical advantages. However, due to the excessive rigidity of bilateral PSF, this instrumentation is suspected to cause the reduction of bone mineral content and degeneration of adjacent segments. Decrease the rigidity of internal fixation and the unilateral construct seems to be more attractive because it avoids soft tissue disruption of the contralateral side, may take less time, and can be associated with lower implant costs. The effectiveness of unilateral fixation as compared to bilateral fixation in lumbar fusion has been frequently investigated in previous studies. The aim of the present study was to review the clinical assessment principles of treatment of lumbar spondylolithesis.