Surgical strategies in degenerative lumbar spondylolisthesis Estratégias operatórias da espondilolistese degenerativa lombar

Objective: The goal of this study is to present surgical methods of nerve elements decompression in the vertebral canal and the techniques of internal spine stabilization in patients with degenerative lumbar spondylolisthesis. Methods: Clinical analysis included 36 patients (17 females and 19 males) managed surgically due to degenerative spondylolisthesis at our Departments, between 1997 and 2003. Intervertebral dislocation exceeding 20% was referred in ten patients where the vertebral column stabilization was achieved by transpedicular stabilization as well as intervertebral and posterolateral spinal fusion (group I). Spondylodesis in spondylolisthesis with the percentage of slippage of lesser than 20% (18 patients) was accomplished by intervertebral cages and posterolateral osseous grafts (group II). In the remaining eight cases, spondylolisthesis was smaller than 20% and with the denivelation of the intervertebral space (group III); nervous structures were liberated and spondylodesis was unnecessary. Results: Low back pain and sciatic neuralgia relieved in 29 (81%) and 31(86%) patients, respectively. Neurological deficits subsided completely in 25 (81%) cases. Conclusions: Strategy of surgery in patients with degenerative lumbar spondylolisthesis is established based in the evaluation of the following factors: vertebral displacement extent, height of intervertebral space and assessment of vertebral column stability.