Spondy Surgery - Latest Research

Hi spondy athletes.  I came across some recent research and case studies discussing surgical approaches for isthmic spondylolisthesis and thought I would share with you all.  Here are the studies I thought were interesting:

1) This study from 2020 looked at using endoscopic decompression surgery alone (without fusion) for adults with isthmic spondylolisthesis and found the results to be successful.  The study was very small and only looked at 2 adults, but the conclusion is still very encouraging.  

"Conclusion: For patients with spondylolisthesis-associated low back and leg pain without spinal instability, TFELD is a safe and effective surgical treatment option."

2) This case study: "Transforaminal endoscopic discectomy to relieve sciatica and delay fusion in a 31-year-old man with pars defects and low-grade spondylolisthesis"

3) This case study: "An Elite Triathlete with High-grade Isthmic Spondylolisthesis Treated by Lumbar Decompression Surgery without Fusion"

4) This study from 2016 performed a systematic review across many other studies to evaluate the outcomes of using various treatment approaches for different types of spondy, including conservative management, surgery with decompression and fusion, and surgery with decompression alone (no fusion).

"Surgery appears to be better than conservative treatment in adults with isthmic SL (poor evidence) and also in adults with degenerative SL (good evidence). Instrumented fusion with decompression appears to be more successful than decompression alone in adults with degenerative SL and spinal stenosis (poor evidence)."

It seems that for those with isthmic spondy, surgery has some evidence of being better than conservative management, but that the evidence was "poor", and that fusion has some evidence of being better than decompression alone for degenerative spondy but that the evidence is also "poor".  It appears they didn't study fusion vs. decompression alone in isthmic spondy, and I can't find much in the literature that does larger comparisons either, unfortunately.

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Overall, in general, fusion still seems to be the "gold standard" for unstable or higher grade spondylolisthesis, but for low grade and stable spondy, it is very interesting and encouraging to see the evolution of medical thinking from what was considered the only surgical approach (fusion) to an approach that only uses decompression to free trapped nerves.  Obviously the above cases in bullets 1-3 represent small data sets and not large scale studies, but to know that successful outcomes and return to function are possible and effective for those without instability due to their spondy using decompression alone is great news for those trying to navigate their way through potential treatment options.

Hope this info is useful!

#crossfit #weightlifting #spondylolisthesis