Surgical versus Nonsurgical Treatment for Lumbar Degenerative Spondylolisthesis

This clinical trial compared surgical treatment with nonsurgical treatment of spondylolisthesis. Because of extensive patient crossover, the data were essentially nonrandomized, and as-treated analyses were performed. During 2 years of follow-up, patients treated surgically had greater improvement in pain and function than those treated nonsurgically. Patients treated nonsurgically showed moderate improvement over time. This clinical trial compared surgical treatment with nonsurgical treatment of spondylolisthesis. During 2 years of follow-up, patients treated surgically had greater improvement in pain and function than those treated nonsurgically. Degenerative spondylolisthesis is the slipping forward of one lumbar vertebra on another with an intact neural arch. It rarely occurs before the age of 50 years, and it disproportionately affects women, particularly black women, with a male:female ratio of approximately 1:6. 1 Slippage most commonly occurs at the L4–L5 level and rarely exceeds 30% of vertebral width. 1 Degenerative spondylolisthesis is generally asymptomatic, but it can be associated with symptomatic spinal stenosis. 1 Spinal stenosis, the most common reason for lumbar surgery in adults over the age of 65, is a narrowing of the spinal canal with encroachment on the neural structures by . . .