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For adolescents with slip greater than Grade II, fusion with instrumentation and decompression may be performed. In order to protect adjacent levels of vertebrae, additional fixation of other vertebrae may be needed. Often fixation of L5 with the ileum or sacrum is done to provide sufficient stability.

The most effective surgery for degenerative spondylolisthesis is thought to be laminectomy together with fusion by bone graft and/or instrumentation. The spondyloptosis of L5 on S1 may be treated with resection of L5 vertebral body with fusion with instrumentation to the pelvis.

Possible complications of laminectomy include:

• Nerve root damage
• Progression of the deformity and increased instability
• Leakage of cerebrospinal fluid (rare)
• Infection (rare)

Reduction of the Isthmic Deformity

This surgical procedure is reserved for young, skeletally immature individuals with severe Grade III or IV slippage and significant deformity. Discussion continues regarding the advantages and disadvantages of reduction surgery. Results indicate an improved fusion rate with reduction surgery. Reduction and stabilization yields significant improvement of the slip angle and the degree of slip.

Advantages include:

• Higher fusion rate
• Biomechanical benefit
• Cosmetic benefit with normal spinal alignment

The major disadvantage is the danger of nerve injury during surgery and further nerve damage. It is critical that any patient undergoing this procedure do so only with a surgeon who is very experienced in this type of surgery.

Use of tobacco, drugs, alcohol, and various types of medications may increase the surgical risk complications.