Degenerative Lumbar Spondylolisthesis Treatment [Neurosurgery Wiki]

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====== Degenerative Lumbar Spondylolisthesis Treatment ======

[[Lumbar Degenerative Spondylolisthesis]] treatment has long been a topic of debate, as multiple modalities are currently utilized. For example, in an analysis, 95,647 Medicare patients with a diagnosis of lumbar DS, 40% were treated with [[corticosteroid]] injections, 37% were treated with [[physical therapy]], and only 22% were treated surgically
((Sclafani JA, Constantin A, Ho PS, Akuthota V, Chan L. Descriptive analysis of spinal neuroaxial injections, surgical interventions, and physical therapy utilization for degenerative lumbar spondylolisthesis within medicare beneficiaries from 2000 to 2011. Spine (Phila Pa 1976) 2017;42(4):240–246. doi: 10.1097/BRS.0000000000001724.)).
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Oster et al. performed a comprehensive search of PubMed, MEDLINE, and EMBASE for all English language studies of all levels of evidence pertaining to [[Spine Patient Outcomes Research Trial]] (SPORT), in accordance with [[Preferred Reporting Items for Systematic Reviews and MetaAnalyses]] guidelines ([[PRISMA]]). 
Although [[intention-to-treat analysis]] failed to show significant differences in patients treated surgically, results of the [[as-treated analysis]] determined statically greater improvements in those patients with spondylolisthesis who were treated surgically as compared to those treated nonoperatively.
((Oster BA, Kikanloo SR, Levine NL, Lian J, Cho W. Systematic Review of Outcomes Following 10-Year Mark of Spine Patient Outcomes Research Trial (SPORT) for Degenerative Spondylolisthesis. Spine (Phila Pa 1976). 2020 Jun 15;45(12):820-824. doi: 10.1097/BRS.0000000000003485. PMID: 32205705.)).
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Compared with normative controls, patients with IS suffer selective atrophy of their multifidus (MF) muscle, whereas their erector spinae (ES) muscle undergoes a compensatory hypertrophy. Advancing age has a detrimental effect on the areas of the lumbar paraspinal muscles (PSMs), whereas female sex predisposes to a decreased psoas muscle area. Multifidus muscle atrophy correlates with PSC, indicating the role of this deep stabilizer in the biomechanical stability of spondylolisthetic spines. This may be of clinical significance in targeted physiotherapy programs during the conservative management of isthmic spondylolisthesis (IS)
((Thakar S, Sivaraju L, Aryan S, Mohan D, Sai Kiran NA, Hegde AS. Lumbar
paraspinal muscle morphometry and its correlations with demographic and
radiological factors in adult isthmic spondylolisthesis: a retrospective review
of 120 surgically managed cases. J Neurosurg Spine. 2016 Jan 15:1-7. [Epub ahead 
of print] PubMed PMID: 26771373.
)).

===== Degenerative Lumbar Spondylolisthesis Surgery =====

see [[Degenerative Lumbar Spondylolisthesis Surgery]]