Lumbar Stenosis and Degenerative Spondylolisthesis


The management of spinal stenosis and spondylolisthesis has evolved over the years. Nonsurgical management is typically attempted first, including activity modification, use of NSAIDs, a structured physical therapy regimen, epidural steroid injections, and patient education on the benefits of a healthy lifestyle (eg, control of diabetes, weight loss programs, exercise, cessation of nicotine consumption). Several surgical options are available for managing lumbar spinal stenosis with or without spondylolisthesis in appropriately selected patients. Techniques include open laminectomy, open arthrodesis, and minimally invasive surgery. Options for anterior column support include posterior lumbar interbody fusion, transforaminal lumbar interbody fusion, lateral lumbar interbody fusion, and anterior lumbar interbody fusion. No clear consensus exists that one technique is superior to another. Anterior column support and interbody fusion are used at the surgeon’s discretion because of the lack of strong data to support better clinical outcomes. Minimally invasive techniques have shown promising results of faster rehabilitation, lower infection rates, and faster return to function.

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