Randomized controlled trials and degenerative grade I spondylolisthesis

Degenerative lumbar spondylolisthesis is one of the most common spinal conditions that is treated in the United States. It is generally treated with non-operative therapy first and many patients ultimately require surgical intervention, which improves quality of life substantially. Across the world, there is significant practice variation regarding whether or not to perform a fusion when patients undergo a decompression of spinal nerves at the level of spondylolisthesis. This chapter explores how randomized clinical trials have helped to inform surgeons and patients about the optimal utilization of fusion surgery. Fusion is the dominant form of surgical treatment in the US and is associated with excellent outcomes. Recent data suggests that fusion might not always be necessary in all cases. The chapter also highlights the importance of modern classification strategies that might help us treat patients with spondylolisthesis more effectively in the future.