Lumbar degenerative spondylolisthesis:: Review of 106 operated cases with degenerative anterior vertebral translation as the predominant aspect of the spondylosis

Degenerative lumbar spondylolisthesis associated with spinal stenosis is a degenerative change that occurs with increasing frequency. This vertebral malalignment can lead to sometimes severe back and radicular leg pain at rest and to neurogenic claudication as well. This paper summarizes a 14-year experience (1979-1992), analyzes the clinical, radiologic, and pathomorphologic data of 106 patients who underwent surgical treatment, and reviews the pathophysiologic dynamic of forward slipping and its combination with other degenerative changes. A discussion of the surgical experience follows in an attempt to achieve a rationale for the surgical treatment. The inhomogeneity of the degenerative changes often associated with the anterior vertebral slippage makes the assessment of treatment problematic. Three kinds of treatment were used: simple decompression (17 patients), decompression and transarticular facet screw fixation of Magerl (18 patients). and decompression with transpedicular screw fixation of the slipped vertebra (71 patients). The best results were achieved in this last group. The most suitable surgical treatment seems to consist of selective undercutting decompression with maximal preservation of the facet joints and transpedicular screw fixation of the slipped vertebra.