A 35-year-old laborer has isthmic spondylolisthesis at L5–S1, Meyerding Grade II (25–50% slip). He has failed 6 months of physiotherapy and analgesics. He has bilateral L5 radiculopathy on EMG. The most appropriate surgical intervention is:
- A L5 posterior decompressive laminectomy alone
- B Posterior lumbar interbody fusion (PLIF) or TLIF with pedicle screw fixation at L4–S1 ✓
- C Anterior lumbar interbody fusion (ALIF) at L5–S1 alone
- D Reduction of the slip to Grade 0 and fusion
Explanation
Isthmic spondylolisthesis Grade II with neurological deficit (radiculopathy) unresponsive to conservative treatment requires surgical stabilization and decompression. PLIF or TLIF (posterior/transforaminal lumbar interbody fusion) with pedicle screw instrumentation from L4 to S1 achieves decompression of the neural elements, restoration of disc height, and solid fusion — this is the current standard for Grade II isthmic spondylolisthesis. Laminectomy alone without fusion risks worsening instability and progressive slip. Reduction of spondylolisthesis Grade II to Grade 0 is controversial with high neurological risk (L5 root stretch). ALIF alone without posterior instrumentation is insufficient for isthmic spondylolisthesis with high slip angles.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.