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Degenerative Spondylolisthesis Treatment
Spondylolisthesis is a spinal condition in which one vertebra slips forward over the vertebra below, leading to back pain and other symptoms; degenerative spondylolisthesis usually occurs in the lumbar spine, especially at the 4th and 5th lumbar vertebrae (L4 and L5). Treatment options for degenerative spondylolisthesis may be non-surgical for lesser cases, and the more
How do we know that surgery may work better then non-operative (aka, conservative care) for the treatment of degenerative spondylolisthesis that was refractory to conservative care? For the answer, we turn to the medical research:
Mapping Treatment for Degenerative Spondylolisthesis
Just like spondylolysis and isthmic spondylolisthesis, people with degenerative spondylolisthesis often respond well to non-operative care (medication, physical therapy, low-force chiropractic care, acupuncture, lumbar bracing, facet injections, and/or epidural steroid injections). However, for patients who were refractory to such conservative treatment, surgical intervention may be needed. 
On that note, let me present two fairly high-level-evidence systematic reviews that support the use of instrumentation with PLF and decompression for the treatment of degenerative spondylolisthesis.
Spondylolisthesis Treatment, Surgery & Symptoms
In 1997, Fischgrund et al.  was awarded the prestigious Volvo Award for their paper that looked at the effectiveness of PLF as a treatment intervention for patients with degenerative spondylolisthesis. They also looked at whether or not the addition of posterior instrumentation (pedicle screws and rods) to the PLF procedure would enhance post-surgical clinical outcomes. The results indicated that good to excellent outcomes were achieved in 76% of the patients at the two-year follow-up. However, although instrumentation led to higher rates of successful fusion (which is a good thing), it did not improve clinical outcomes of these patients. 
70) Weinstein JN, Lurie JD, Tosteson TD, et al. Surgical compared with non-operative treatment for lumbar degenerative spondylolisthesis: four-year results in the Spine Patient Outcomes Research Trial (SPORT) randomized and observational cohorts. J Bone Joint Surg (Am) 2009;91:1295-1304.
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