A 35-year-old laborer has isthmic spondylolisthesis at L5–S1 (Grade II by Meyerding — 26–50% slip). He has failed 6 months of conservative management with persistent radiculopathy and low back pain. The preferred surgical treatment is:
- A Decompression and instrumented posterolateral fusion with/without interbody support ✓
- B Decompressive laminectomy alone
- C Posterior spinal fusion (PLF) with instrumentation without decompression
- D PLIF alone at L5-S1 without pedicle screw instrumentation
Correct answer: A. Decompression and instrumented posterolateral fusion with/without interbody support
Explanation
For isthmic spondylolisthesis Grade II (25–50% slip) with persistent symptoms after conservative management, the recommended surgical treatment is decompression of the neural elements (to relieve radiculopathy) combined with instrumented posterolateral fusion (to stabilize the listhesis and prevent further progression). Adding interbody support (PLIF/TLIF) improves fusion rates and restores disc height, particularly for higher-grade slips. Decompression alone (laminectomy) at an unstable segment risks worsening the listhesis and is contraindicated.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.