Management of spondylolysis and spondylolisthesis in the pediatric and adolescent population.

Spondylolysis and low-grade spondylolisthesis are diagnoses that, for most patients, have a benign prognosis and can be managed nonoperatively. For most symptomatic patients for whom this management fails, fusion in situ yields satisfactory and lasting results and remains the gold standard against which other surgical treatment must be compared. Patients with high-grade slips and slip angles may benefit from instrumented fusion in situ or combined anterior/posterior procedures, or may be considered for reduction and fusion. Reduction maneuvers are technically demanding and carry significant risk of neurologic injury. Surgical experience and in-depth understanding of the indications, the complications, and, especially, the limitations of each technique are required.