Treatment of instability and spondylolisthesis: surgical versus nonsurgical treatment.

UNLABELLED: Spondylolisthesis is a common cause of lower-back pain, radiculopathy, and neurogenic claudication among the adult population. Treatment should begin with nonoperative measures that may include physical therapy, aerobic exercise, epidural steroid injections, and homeopathic remedies. If these treatments fail, surgical intervention may provide the patient pain relief and improvement in neurologic symptoms. The use of instrumentation for posterolateral fusions as well as interbody fusion may improve clinical outcomes for those having surgical intervention. We discuss the current nonoperative modalities and surgical techniques treating degenerative spondylolisthesis. LEVEL OF EVIDENCE: Level V: Expert Opinion. See the Guidelines for Authors for a complete description of the levels of evidence.