Historical evolution, management, and outcome of surgical treatment for high-grade spondylolisthesis: a systematic review

OBJECTIVE: High-grade spondylolisthesis (HGSL) is a rare condition characterized by a vertebral slippage of more than 50% relative to the inferior adjacent vertebra. Despite the range of surgical techniques available, there is no consensus regarding the optimal management approach for HGSL. Although various interventions are documented in the literature, definitive guidelines remain absent. In this systematic review the authors aimed to provide a comprehensive analysis of the chronological evolution of surgical management strategies for HGSL, along with the clinical and radiographic outcomes and complications, to assist surgeons in selecting the optimal approach for their patients. METHODS: PubMed, Ovid MEDLINE, Cochrane, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Scopus were systematically searched for eligible studies published in peer-reviewed journals up until May 2024. Following data extraction, the National Institutes of Health quality assessment tools were used to evaluate the methodological quality of the included studies. RESULTS: Of 1798 papers found in the literature, 33 met the inclusion criteria. Eligible articles assessed 463 patients with HGSL. Fifteen papers described the reduction approach, whereas 19 papers described the in situ fusion technique. Most of the reported neurological injuries were associated with reduction techniques, whereas most of the graft failures were associated with Bohlman's technique. Most patients in both the in situ fusion and the decompression and fusion groups reported good outcomes postoperatively in terms of back pain and leg pain. CONCLUSIONS: The historical progression of HGSL treatment, from the early interventions in 1932 to the techniques used today, has been pivotal in shaping patient outcomes. The authors' findings have many implications for clinical practice, and they provide a framework for implementing treatment guidelines. The authors underscore the importance of a comprehensive evaluation of the benefits and risks of each surgical approach, with particular emphasis on customizing interventions to accommodate the specific anatomical features of each patient.