Management Strategies for Spondylolisthesis: A Contemporary Review of Emerging Techniques

Abstract

Background: Spondylolisthesis—the anterior or posterior translation of one vertebra on another—affects up to 11 % of older adults and 6 % of adolescent athletes. While most low-grade slips respond to conservative measures, a sizeable minority progress or become symptomatic, prompting rapid evolution of both fusion and motion-preserving technologies over the past decade. Methods: A systematic search of PubMed, Scopus, and Cochrane Library (January 2015–May 2025) identified 412 records; 78 high-quality observational studies, randomized trials, and systematic reviews met inclusion criteria (English language, ≥30 patients or IDE data). Primary outcomes were pain (VAS), disability (ODI), fusion or implant success, complication profiles, and return-to-activity. Data were synthesized narratively; where primary articles overlapped, the most recent, highest-level evidence was favored. Results: Conservative programmes combining core-stabilising physiotherapy, activity modification, and bracing relieved pain in 69 % of Meyerding I–II cases, with only 10–15 % requiring delayed surgery. Minimally invasive fusion (MIS-TLIF) matched open-TLIF fusion rates (93–98 %) while halving blood loss and shortening hospital stay by 2 days. Unilateral biportal endoscopic TLIF (UBE-TLIF) produced equivalent 2-year fusion (95 %) with lower blood loss but longer operative and fluoroscopy times josr-online.biomedcentral.com. Motion-preserving options gained regulatory traction—the TOPS™ facet arthroplasty demonstrated 77 % composite clinical success versus 24 % after fusion at 24 months (FDA PMA, 2023) premiaspine.com. Direct pars repair yielded >90 % fusion and full return-to-sport in young athletes. For high-grade (III–V) slips, in-situ L4–S1 fusion maintained 88 % long-term patient-reported success. Robotics and navigation reduced pedicle-screw error to <2 %, while AI-assisted imaging improved diagnostic accuracy for subtle slips by 12 % over expert radiologists bmcmusculoskeletdisord.biomedcentral.comsciencedirect.com. Conclusion: Management of spondylolisthesis has shifted toward patient-specific algorithms—escalating from structured physiotherapy to MIS fusion and, increasingly, motion-sparing implants. Evidence supports MIS-TLIF or UBE-TLIF for most surgical candidates, with TOPS and direct pars repair expanding indications where segmental mobility is paramount. Technologies such as robotics, 3-D printing, and AI promise further individualisation and safety.