Decompression

Decompression of the neural elements should be considered in adults with radicular symptoms or neurological deficits from isthmic or degenerative spondylolisthesis. Techniques range from removal of the loose lamina and cartilaginous mass around the isthmic defect, as originally described by Gill et al. in 1955, to a combination of laminectomy, foraminotomy, facetectomy, and discectomy in patients with degenerative spondylolisthesis. With decompression alone, improvement is obtained in a majority of patients but may lead to a high incidence of progressive slippage. Interestingly, such progression does not always distract significantly from a good clinical outcome.

Although good results can be obtained by decompression without coincident bony fusion, when patients without fusion are compared with those who undergo fusion, better results are generally seen in the fusion group. Of course, complications directly related to the fusion such as bone graft donor site pain and infection must be considered as well.