Last updated January 5, 2022

Diagnosis And Treatment Of Degenerative Lumbar Spondylolisthesis

Recommendations

Definition

An acquired anterior displacement of one vertebra over the subjacent vertebra, associated with 13 degenerative changes, without an associated disruption or defect in the vertebral ring. (, )
(Work Group Consensus Statement)
317978

Diagnosis and Imaging

In the absence of evidence to address this question, it is the work group’s opinion that obtaining an 20 accurate history and physical examination is important for the diagnosis and treatment of patients 21 with degenerative lumbar spondylolisthesis. Formulating appropriate clinical questions is essential 22 to obtaining an accurate history that can be used in developing a treatment plan for patients. (, )
(Work Group Consensus Statement)
317978
The lateral radiograph is the most appropriate, noninvasive test for detecting degenerative lumbar spondylolisthesis. (B: Suggested)
317978
In the absence of reliable evidence, it is the work group’s opinion that the lateral radiograph should 9 be obtained in the standing position whenever possible. (, )
(Work Group Consensus Statement)
317978
The most appropriate, noninvasive test for imaging the stenosis accompanying degenerative lumbar spondylolisthesis is MRI. (, )
(Work Group Consensus Statement)
317978
Facet joint effusion greater than 1.5mm on supine MRI may be suggestive of the presence of 17 degenerative lumbar spondylolisthesis. Further evaluation for the presence of degenerative lumbar spondylolisthesis should be considered, including using plain standing radiographs. (B: Suggested)
317978
There is insufficient evidence to make a recommendation for or against the utility of the upright seated MRI in the diagnosis of degenerative lumbar spondylolisthesis. (Insufficient)
317978
There is insufficient evidence to make a recommendation for or against the use of axial loaded MRI 2 to evaluate the dural sac cross sectional area in patients with degenerative lumbar spondylolisthesis and spinal stenosis. (Insufficient)
317978
Plain myelography or CT myelography are useful studies to assess spinal stenosis in patients with degenerative lumbar spondylolisthesis especially in those who have contraindications to MRI. (B: Suggested)
317978
In patients with degenerative lumbar spondylolisthesis with associated spinal stenosis for whom MRI 12 is either contraindicated or inconclusive, CT myelography is suggested as the most appropriate test 13 to confirm the presence of anatomic narrowing of the spinal canal or the presence of nerve root impingement. (, )
(Work Group Consensus Statement)
317978
In patients with degenerative spondylolisthesis with associated spinal stenosis for whom MRI and CT 18 myelography are contraindicated, inconclusive or inappropriate, CT is suggested as the most 19 appropriate test to confirm the presence of anatomic narrowing of the spinal canal or the presence of nerve room impingement. (, )
(Work Group Consensus Statement)
317978
There is no universally accepted standard to diagnose fixed versus dynamic spondylolisthesis. To 6 evaluate instability, many studies employ the use of lateral flexion extension radiographs, which may 7 be done in the standing or recumbent position; however, there is wide variation in the definition of 8 instability. To assist the readers, the definitions for instability (when provided) in degenerative spondylolisthesis patients, are bolded below. (Insufficient)
317978
There is insufficient evidence to make a recommendation for or against the utility of dynamic MRI and dynamic CT myelography in the diagnosis of degenerative lumbar spondylolisthesis. (Insufficient)
317978

Medical/Interventional Treatment

Medical/interventional treatment for degenerative lumbar spondylolisthesis, when the radicular 23 symptoms of stenosis predominate, most logically should be similar to treatment for symptomatic degenerative lumbar spinal stenosis. (, )
(Work Group Consensus Statement)
317978
An updated systematic review of the literature yielded no studies to adequately address any of the 4 medical/ interventional treatment questions from the original guideline posed below:
  • What is the role of pharmacological treatment in the management of degenerative lumbar spondylolisthesis?
  • What is the role of physical therapy/exercise in the treatment of degenerative lumbar spondylolisthesis?
  • What is the role of manipulation in the treatment of degenerative lumbar spondylolisthesis?
  • What is the role of ancillary treatments such as bracing, traction, electrical stimulation and transcutaneous electrical stimulation (TENS) in the treatment of degenerative lumbar spondylolisthesis?
  • What is the long-term result (four + years) of medical/interventional management of degenerative lumbar spondylolisthesis?
There is insufficient evidence to make a recommendation for or against the use of injections for the treatment of degenerative lumbar spondylolisthesis. (Insufficient)
317978

Surgical Treatment

Direct surgical decompression may be considered for the treatment of patients with symptomatic 2 spinal stenosis associated with low grade degenerative lumbar spondylolisthesis whose symptoms have been recalcitrant to a trial of medical/interventional treatment. (C: Optional)
317978
There is insufficient evidence to make a recommendation for or against the use of indirect surgical 7 decompression for the treatment of patients with symptomatic spinal stenosis associated with low 8 grade degenerative lumbar spondylolisthesis whose symptoms have been recalcitrant to a trial of medical/interventional treatment. (Insufficient)
317978
Surgical decompression with fusion is suggested for the treatment of patients with symptomatic 16 spinal stenosis and degenerative lumbar spondylolisthesis to improve clinical outcomes compared with decompression alone. (B: Suggested)
317978
For symptomatic single level degenerative spondylolisthesis that is low-grade (<20%) and without 22 lateral foraminal stenosis, decompression alone with preservation of midline structures provide equivalent outcomes when compared to surgical decompression with fusion. (B: Suggested)
317978
Surgical decompression with fusion, with or without instrumentation, is suggested to improve the 6 functional outcomes of single-level degenerative lumbar spondylolisthesis compared to medical/interventional treatment alone. (B: Suggested)
317978
There is insufficient evidence to make a recommendation for or against efficacy of surgical 11 decompression with fusion, with or without instrumentation, for treatment of multi-level degenerative lumbar spondylolisthesis compared to medical/interventional treatment alone. (Insufficient)
317978
The addition of instrumentation is suggested to improve fusion rates in patients with symptomatic spinal stenosis and degenerative lumbar spondylolisthesis. (B: Suggested)
317978
The addition of instrumentation is not suggested to improve clinical outcomes for the treatment of patients with symptomatic spinal stenosis and degenerative lumbar spondylolisthesis. (B: Suggested)
317978
There is insufficient evidence to make a recommendation for or against the use of either decompression with posterolateral fusion or 360o 5 fusion in the surgical treatment of patients with degenerative lumbar spondylolisthesis. (Insufficient)
317978
There is insufficient and conflicting evidence to make a recommendation for or against the efficacy of Page 15 of 32 16 1 interspinous spacers versus medical/interventional treatment in the management of degenerative lumbar spondylolisthesis patients. (Insufficient)
317978
There is insufficient evidence to make a recommendation for or against the use of reduction with fusion in the treatment of degenerative lumbar spondylolisthesis. (Insufficient)
317978
There is insufficient evidence to make a recommendation for or against the use of autogenous bone 18 graft or bone graft substitutes in patients undergoing posterolateral fusion for the surgical treatment of degenerative lumbar spondylolisthesis. (Insufficient)
317978
While both minimally invasive techniques and open decompression and fusion, with or without 6 instrumentation, demonstrate significantly improved clinical outcomes for the surgical treatment of 7 degenerative lumbar spondylolisthesis, there is conflicting evidence which technique leads to better outcomes. (Insufficient)
317978
Decompression and fusion may be considered as a means to provide satisfactory long-term results 15 for the treatment of patients with symptomatic spinal stenosis and degenerative lumbar spondylolisthesis. (C: Optional)
317978
There is insufficient evidence to make a recommendation for or against the influence of a non23 organic pain drawing on the outcomes/prognosis of treatments for patients with degenerative lumbar spondylolisthesis. (Insufficient)
317978
There is insufficient evidence to make a recommendation regarding the influence of age and three or 4 more co-morbidities on the outcomes of patients undergoing treatment for degenerative lumbar spondylolisthesis. (Insufficient)
317978
There is insufficient evidence to make a recommendation regarding the influence of obesity (BMI >30) and its impact on treatment outcomes in patients with degenerative lumbar spondylolisthesis. (Insufficient)
317978

Value/Cost-Effectiveness of Spine Care

There is insufficient evidence to make a recommendation for or against the cost-effectiveness of 13 minimal access-based surgical treatments compared to traditional open surgical treatments for degenerative lumbar spondylolisthesis. (Insufficient)
317978

Recommendation Grading

Overview

Title

Diagnosis And Treatment Of Degenerative Lumbar Spondylolisthesis

Authoring Organization

Publication Month/Year

November 5, 2015

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Female, Male, Adult, Older adult

Health Care Settings

Ambulatory, Emergency care, Hospital, Operating and recovery room, Outpatient

Intended Users

Physical therapist, chiropractor

Scope

Assessment and screening, Diagnosis, Rehabilitation, Management, Treatment

Diseases/Conditions (MeSH)

D013168 - Spondylolisthesis

Keywords

lumbar spondylolysthesis, Degenerative Lumbar Spondylolisthesis