! Management of high-grade spondylolisthesis (HGS) remains challenging and is associated with significant controversies.

SUMMARYManagementofhigh-gradelumbosacralspondylo-listhesis is complex and is associated with signifi-cant controversies. Although there is generalconsensus on the need for surgical treatment ofsymptomatic patients presenting with severe pain,neurologic deficits, or progressive deformity oncesymptomatic or progressive, the optimal surgicalapproach and techniques remain controversial.Recent advances in spinal instrumentation,improved understanding of the pelvic anatomyanditsroleindeterminingsagittalspinopelvicalign-ment,anditsinfluenceonthedevelopmentofHGShave had a significant impact on surgical manage-ment of HGS. Although not proven in randomizedstudies, posterior instrumented fixation and fusionwith attempted partial deformity reduction and in-terbodystructuralsupporthavebeengainingwide-spread acceptance, and have been shown toprovidesatisfactoryratesoffusionandagoodclin-ical outcome. Regardless of the choice of surgicaltechnique,significantcomplicationscanbeassoci-ated with the surgical treatment of HGS and maydictate the type of surgical approach chosen.REFERENCES