In the management of isthmic spondylolisthesis (Meyerding Grade II–III), the preferred surgical procedure in a young adult with significant symptoms and >50% slip is:
- A Posterior decompression (laminectomy) alone
- B Posterolateral in-situ fusion without reduction
- C Reduction and interbody fusion (PLIF/TLIF) with pedicle screw fixation ✓
- D Anterior lumbar interbody fusion alone
Correct answer: C. Reduction and interbody fusion (PLIF/TLIF) with pedicle screw fixation
Explanation
For isthmic spondylolisthesis Grade II–III (25–75% slip) in young symptomatic patients, reduction and instrumented interbody fusion (PLIF/TLIF with pedicle screws) is preferred. Reduction restores lumbar lordosis, reduces foraminal compromise, and decreases the high shear stress at the slip level. In-situ fusion without reduction has acceptable results for low-grade slips but is less effective for Grade II–III with significant deformity. Laminectomy alone destabilizes the slip. The Bohlman modified three-wire in-situ fusion is reserved for elderly or high-risk patients.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
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Written and medically reviewed by the StethoPrep medical team.