A 40-year-old man with Grade II isthmic spondylolisthesis (Meyerding) at L5-S1 has persistent low back pain and L5 radiculopathy despite 3 months of conservative treatment. The MOST appropriate surgical option is:

• A Decompressive laminectomy alone
• B Posterolateral fusion (PLF) without decompression
• C Reduction alone using distraction instrumentation
• D Transforaminal lumbar interbody fusion (TLIF) at L5-S1 with pedicle screw fixation ✓

Explanation

Grade II isthmic spondylolisthesis with radiculopathy failing conservative management requires both neural decompression and spinal fusion. TLIF (or PLIF) at L5–S1 with pedicle screw fixation provides circumferential stabilisation, foraminal height restoration (decompressing the L5 root trapped at the pars defect), and fusion. Laminectomy alone without fusion is contraindicated as it destabilises the already slipping segment. Posterolateral fusion alone may not adequately decompress the foraminal nerve root. Current guidelines favour instrumented TLIF for symptomatic Grade II spondylolisthesis.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.