BACKGROUND: Low-grade isthmic and degenerative spondylolisthesis (DS) of the lumbar spine are distinct pathologies but both can be treated with lumbar decompression with fusion. In a very large cohort, we compared patient-reported outcome in relation to the pathology and chief complaint at baseline.
METHODS: This was a retrospective analysis using the EUROSPINE Spine Tango Registry. We included 582 patients (age 60 ± 15 years; 65% female), divided into four groups based on two variables: type of spondylolisthesis and chief pain complaint (leg pain (LP) versus back pain). Patients completed the COMI preoperatively and up to 5 years follow-up (FU), and rated global treatment outcome (GTO). Regression models were used to predict COMI-scores at FU. Pain scores and satisfaction ratings were analysed.
RESULTS: All patients experienced pronounced reductions in COMI scores. Relative to the other groups, the DS-LP group showed between 5% and 11% greater COMI score reduction (p < 0.01 up to 2 years\' FU). This group also performed best with respect to pain outcomes and satisfaction. Long-term GTO was 93% at the 5 year FU, compared with between 82% and 86% in the other groups.
CONCLUSIONS: Regardless of the type of spondylolisthesis, all groups experienced an improvement in COMI score after surgery. Patients with DS and LP as their chief complaint appear to benefit more than other patients. These results are the first to show that the type of the spondylolisthesis and its chief complaint have an impact on surgical outcome. They will be informative for the consent process prior to surgery and can be used to build predictive models for individual outcome.

OBJECTIVE: To assess the national and regional trend in the prevalence of lumbar spondylolysis and isthmic spondylolisthesis for adolescent males in South Korea from 2015 to 2022.
METHODS: A total of 2,666,277 Korean adolescent males were routinely examined at regional Military Manpower Administration offices. The data gathered from Military Manpower Administration were retrospectively collected to measure the prevalence and 95% confidence interval of lumbar spondylolysis and isthmic spondylolisthesis according to the year and region in South Korea. The Spearman correlation analysis was performed to assess the correlation between lumbar spondylolysis, isthmic spondylolisthesis, and several factors including height, weight, current smoking rate, and occasional and high-risk alcohol consumption.
RESULTS: The prevalence of spondylolysis per 10,000 individuals showed a gradual increasing trend from 2015 to 2022 On the contrary, the prevalence of isthmic spondylolisthesis per 10,000 individuals decreased over a consecutive 8-year period. There were no statistical differences in the prevalence of spondylolysis and isthmic spondylolisthesis between Greater Seoul and the countryside. The prevalence of isthmic spondylolisthesis was significantly correlated with occasional (r=0.81, P=0.015) and high-risk alcohol consumption (r=0.86, P=0.007).
CONCLUSIONS: The prevalence of lumbar spondylolysis among adolescent men has increased, whereas isthmic spondylolisthesis has shown a decline over a consecutive 8-year period. The trends in prevalence for both lumbar spondylosis and isthmic spondylolisthesis were similar across the regions in South Korea. Notably, there was a significant correlation between the prevalence of isthmic spondylolisthesis and the rate of alcohol consumption in adolescent men.

Spondylolysis with pseudarthrosis may be treated surgically by repairing the spondylolysis using the smiley face rod (SFR) technique. The SFR technique can avoid adjacent segmental disease caused by transforaminal lumbar interbody fusion (TLIF), which is one of the main surgical techniques to treat isthmic lumbar spondylolisthesis. A 59-year-old woman had been playing softball since she was 12 years old and was a member of a prefectural representative team. She sought treatment because of numbness in her left lower limb and difficulty playing softball. Despite conservative treatment for a year, her symptoms did not improve. Physical examination revealed decreased patellar tendon reflexes and numbness and pain from the front of the thigh to the lower leg without muscle weakness. Imaging showed L4 isthmic spondylolisthesis with Meyerding classification grade 2 anterior slip and L5 spondylolysis with pseudarthrosis. We diagnosed L4 radiculopathy caused by L4/5 foraminal stenosis and L4 isthmic spondylolisthesis with L5 spondylolysis. She underwent surgery combining the TLIF of L4/5 and the SFR technique of L5 using dual-headed pedicle screws that can fix two types of rods with L5 pedicle screws. Three months after surgery, fusion between L4/5 and fusion of the L5 pars cleft were confirmed. She resumed sports, and one year postoperatively, she was able to participate in softball games. Two years postoperatively, she could bat, run, and play defense without adjacent segmental disease. Two-segment TLIF increases adjacent segmental disease more than single-segment TLIF. Because the L5 spondylolysis had not slipped, we chose the SFR technique to preserve mobility at L5/S1. The dual-headed pedicle screw fastens two-type rods at the head of the pedicle screw, making it a suitable design for this procedure.

OBJECTIVE: This study analyzed and explored the relationship between isthmic spondylolisthesis and disc degeneration by comparing the degree of disc degeneration in patients with isthmic spondylolisthesis, lumbar disc herniation, and asymptomatic healthy individuals.
METHODS: This study included a total of 138 cases, consisting of L5-S1 single segment lesion patients and a normal lumbar spine population. The cases were divided into 3 groups based on the type of disease: fifty eight cases in the isthmic spondylolisthesis (IS) group, 50 cases in the lumbar disc herniation (LDH) group, and 30 cases in the normal lumbar vertebrae (NLV) group.
RESULTS: The research findings indicate that the proportion of intervertebral disc degeneration in the LDH group is significantly higher than that in the IS group and NLV group (65.3% vs. 33.3% vs. 25.8%, P < 0.05). The Pfirrmann grades of lumbar intervertebral discs (L1-L4) in the LDH group are significantly higher than those in the IS group and NLV group (P < 0.05), and the intervertebral height index (IHI) (L1-L4) of lumbar vertebrae in the LDH group is significantly lower than that in the IS group and NLV group (P < 0.05).
CONCLUSIONS: The results showed that the degree of intervertebral disc degeneration in patients with isthmic spondylolisthesis was lighter than that in patients with LDH, and even similar to that in healthy individuals. The occurrence of IS may have slowed down the degeneration of nonaffected segment intervertebral discs through certain factors.

OBJECTIVE: To compare the morphometry of paraspinal muscles in patients with degenerative spondylolisthesis (DS), isthmic spondylolisthesis (IS), and healthy individuals.
METHODS: Thirty-seven pairs of DS patients were selected using propensity score matching with IS patients, while 37 healthy individuals matched for age, sex, and BMI were selected as controls. The relative cross-sectional area (rCSA), and relative functional cross-sectional area (rfCSA) of paraspinal muscles were measured, and the degree of fatty infiltration (FI) was calculated. Based on occupational differences, the patients were also divided into worker and farmer groups, and the same measurements were taken on them.
RESULTS: At the L3/L4 level, the multifidus (MF) FI was greater in the DS and IS groups than in the control group, the erector spinae (ES) rfCSA was higher in the IS group than in the DS and control groups. At the L4/L5 level, MF rfCSA was smaller in the DS and IS groups than in the control group; ES rfCSA was higher in the IS group than in the DS and control groups. At the L5/S1 level, MF rfCSA was smaller in the DS and IS groups than in the control group; ES rfCSA was higher in the IS group than in the DS group. At the L3/L4, L4/L5 level, MF rfCSA were higher in the worker group than in the farmer group (p < 0.05).
CONCLUSIONS: The morphological changes in paraspinal muscles in patients with DS were dominated by selective atrophy of the MF, while in patients with IS, the morphological changes in paraspinal muscle showed selective atrophy of the MF accompanied by compensatory hypertrophy of the ES. The surgeon should consider the morphological differences in paraspinal muscle between different types of lumbar spondylolisthesis when establishing the appropriate surgical program.

METHODS: Randomized controlled trial.
OBJECTIVE: To compare the effect of posterolateral fusion (PLF) and posterior lumbar interbody fusion (PLIF) on sagittal radiographic parameters in patients with low-grade isthmic spondylolisthesis. Additionally, to explore the correlation between changes in these parameters and clinical outcomes.
METHODS: Forty-six consecutive patients with single-level low-grade isthmic spondylolisthesis were initially enrolled. They were randomly assigned to undergo either PLF or PLIF. Patients were followed up for at least 24 months. Radiographic outcomes included pelvic incidence, pelvic tilt, sacral slope, lumbar lordosis, sagittal vertical axis, T1 pelvic angle, slip angle, slip degree and disc height. Clinical outcomes were assessed by the Oswestry Disability Index (ODI) and visual analogue scale (VAS).
RESULTS: Four participants were lost to follow-up. Of the remaining 42 patients, 29 were female. The mean age was 40.23 ± 10.25 years in the PLF group and 35.81 ± 10.58 years in the PLIF group. There was a statistically significant greater correction of all radiographic parameters in the PLIF group. The ODI and VAS improved significantly in both groups, with no significant differences between the two groups. Changes in the ODI and VAS were significantly correlated with changes in disc height, slip angle and lumbar lordosis.
CONCLUSIONS: In patients with low-grade isthmic spondylolisthesis, PLIF demonstrates superior efficacy compared to PLF in correcting sagittal radiographic parameters. Nevertheless, this distinction does not seem to influence short-term clinical results. Restoring disc height, correcting the slip angle, and reestablishing normal lumbar lordosis are crucial steps in the surgical management of isthmic spondylolisthesis.

UNASSIGNED: In this study, we evaluated the therapeutic outcomes of transforaminal epidural steroid injection (TFESI) in managing chronic radicular pain due to foraminal stenosis. Furthermore, we evaluated its effectiveness according to isthmic spondylolisthesis (IS) severity.
UNASSIGNED: We included 40 patients with radicular pain due to IS-derived foraminal stenosis in our study and treated them with TFESI. Two patients were lost during follow-up. Based on the lateral lumbar radiograph findings, we allocated the recruited patients with < 25% slippage by IS to Group 1 (n = 23) and those having 25-50% slippage to Group 2 (n = 15). The degree of pain was measured using a numeric rating scale (NRS) at pre-treatment and 1 and 2 months after TFESI.
UNASSIGNED: In 38 patients who completed the study, the NRS at pre-treatment was significantly reduced at the 1- and 2-month follow-ups. In the Group analysis, the NRS scores were significantly reduced after TFESI in both Groups 1 and 2, regardless of IS severity. However, the reduction in NRS scores 1 month after TFESI was significantly greater in Group 1 than in Group 2. Moreover, the rate of successful treatment outcomes was significantly higher (65.2%) in Group 1 than in Group 2 (26.7%).
UNASSIGNED: After TFESI, chronic radicular pain was significantly reduced regardless of IS severity, and its effect persisted for at least 2 months. However, its effect was superior when the vertebra slippage by IS was less than 25% compared to patients with 25%-50%.

UNASSIGNED: Lumbar spondylolysis is a common fatigue fracture of the pars interarticularis of the lamina of the lumbar spine in adolescent athletes presenting with pars clefts. Some pseudarthrotic lumbar spondylolysis causes low back pain or radiculopathy. This study presents a case of pseudarthrotic lumbar spondylolysis that was successfully treated using a modified smiley face rod technique.
UNASSIGNED: We developed a modified smiley face rod technique, which places pedicle screws in the lateral edge of the pedicle to preserve the erector spinae muscles and inserts a U-shaped rod between the spinous processes to preserve the supraspinous ligament. When a U-shaped rod penetrates the interspinous ligament subcutaneously, the resection of the supraspinous ligaments can be avoided. When the screw head is positioned more anterolaterally, a compression force is applied perpendicular to the surface of the pars cleft by rod clamping. This intrasegmental fusion technique preserves the mobile segment and simultaneously repairs the pars cleft. It is less invasive and more appropriate than interbody fusion for young athletes to avoid the possibility of future adjacent segment disorders.
UNASSIGNED: This is a minimally invasive procedure that can easily achieve bone fusion and should be introduced for patients who are suffering from the symptoms of pseudarthrotic lumbar spondylolysis.

METHODS: Retrospective analysis of prospectively collected data.
OBJECTIVE: Isthmic spondylolisthesis (iSPL) occurs most commonly in L5/S1 and L4/5. This study investigates the association between spinopelvic anatomy and the pathogenesis of iSPL.
METHODS: Spinopelvic parameters as well as severity of slip grade were measured in sagittal spine radiographs of symptomatic patients with iSPL in segments L4/5 and L5/S1. Means were calculated and differences between both groups were analyzed. A correlation between the analyzed parameters and degree of slippage was performed.
RESULTS: We included 73 subjects in this study; 11 in L4/5 group and 62 in L5/S1 group. Pelvic anatomy significantly differed between L4/5 and L5/S1 iSPL (Pelvic Incidence (PI) 54.8° vs 66.3°, P value = .006; Pelvic Radius (PR) 124.4 mm vs 137.4 mm; P value = .005 and Sacral Table Angle (STA) 101.0° vs 92.2°, P value < .001). The relative degree of slippage was significantly higher in the L5/S1 group (L4/5 29.1% vs L5/S1 40.1%, P value .022). We also observed a significant correlation between pelvic anatomy and the severity of the slip in iSPL at the L5/S1 level.
CONCLUSIONS: Pelvic parameters PI and STA play an important role concerning the level of occurrence and severity of iSPL. Spinopelvic anatomy determines the pathogenesis of iSPL.

The optimal surgical management of low- and high-grade isthmic spondylolisthesis (LGS and HGS -IS) is debated as well as whether reduction is needed especially for high-grade spondylolisthesis. Both anterior and posterior techniques can be associated with mechanical disadvantages as hardware failure with loss of reduction and L5 injury. We purpose a novel endoscopic-assisted technique (Sled technique, ST) to achieve a complete reduction in two surgical steps: first anteriorly through a retroperitoneal approach to obtain the greatest part of correction and then posteriorly to complete reduction in the same operation.
ST efficacy and complications rate were evaluated through a retrospective functional and radiological analysis.
Thirty-one patients, 12 male (38.7%) and 19 female (61.3%), average age: 45.4 years with single level IS underwent olisthesis reduction by ST. Twenty-three IS involved L5 (74.2%), 7 L4 (22.5%) and 1 L3 (3.3%). No intraoperative complications were recorded. One patient required repositioning of a pedicle screw. A significant improvement of functional and radiological parameters (L4-S1 and L5-S1 lordosis) outcomes was recorded (p < 0.001).
ST provides a complete reduction in the slippage in LGS and HGS. The huge anterior release as well as the partial reduction in the slippage by the endoscopic-assisted anterior procedure, because of the cage is acting as a \"guide rail\", facilitate the final posterior reduction, always complete in our series, minimizing mechanical stresses and neurological risks.
gov Identifier: NCT03644407.