Surgical Management of High-Grade Spondylolisthesis

Abstract High-grade spondylolisthesis, defined as Meyerding grades III, IV, and V or greater than 50% anterior translation, represent a unique spinal pathology. Most commonly isthmic in etiology and predominantly affecting adolescent patients, these slips are associated with unique management considerations and surgical challenges for treatment. Reduction and decompression are controversial management strategies, whereas fusion has long been the definitive surgical modality to prevent slip progression and neurologic deterioration. Fusion methods including posterior in situ, posterior instrumented, anterior, and circumferential have been reported with varying successes. We examine the evolution of our evaluation and surgical management of these challenging clinical scenarios.