A 45-year-old man has L4–L5 isthmic spondylolisthesis with grade II slip (25–50% according to Meyerding classification). Despite 6 months of conservative management he has persistent radiculopathy and mechanical back pain. The most appropriate surgical procedure is:
- A Decompressive laminectomy alone (without fusion)
- B Anterior discectomy alone without fusion
- C Posterolateral fusion with instrumented pedicle screw fixation, with or without interbody fusion (PLIF/TLIF) ✓
- D Spondylolisthesis reduction to anatomical position is mandatory before fusion
Explanation
Grade II isthmic spondylolisthesis with symptoms refractory to conservative management requires both decompression and spinal fusion. Decompression alone (laminectomy) without fusion is inadequate and worsens instability. The current standard is instrumented posterolateral fusion (pedicle screws + rods + lateral gutters bone graft) with or without an interbody device (PLIF/TLIF) which provides anterior column support, restores disc height, and indirectly decompresses foramina. Complete reduction to anatomical alignment is controversial and associated with neurological risk (L5 nerve root tethering); in-situ or partial reduction with fusion is generally preferred for grades I–II. Complete reduction may be considered for grade III/IV in young patients.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.