This protocol applies to patients with low-grade isthmic spondylolisthesis — Meyerding Grade I or II — in whom a prior course of epidural steroid injection did not deliver adequate short-term pain reduction or functional improvement.
Isthmic spondylolisthesis arises from a defect or fracture in the pars interarticularis, often driven by repetitive mechanical stress, and frequently progresses from a pre-existing spondylolysis. At Meyerding Grades I and II the vertebral slip remains low grade. Conservative management — including injection-based approaches — is the standard first response for patients with mild to moderate symptoms and no significant neurological compromise, but a subset of patients do not respond sufficiently.
The previous management step was epidural steroid injection. Escalation to this protocol is indicated when that intervention failed to achieve the expected short-term pain reduction and functional improvement in the setting of low-grade isthmic spondylolisthesis.
The evidence-based next step involves surgical intervention — structural stabilisation of the affected spinal segment is the central aim, given the instability inherent to the pars defect. The choice of specific surgical technique and patient selection criteria depend on individual case factors. The complete algorithm is available in the structured protocol below.
Success is defined by relief of low back pain, solid spinal fusion confirmed on imaging, and reduction of the vertebral slip on imaging.
Isthmic spondylolisthesis is primarily associated with a defect or fracture in the pars interarticularis, often caused by repetitive mechanical stress, and frequently progresses from a pre-existing spondylolysis.
Conservative treatment is typically recommended for patients with low-grade spondylolisthesis (grades I and II), especially those who are asymptomatic or have mild to moderate symptoms without significant neurological deficits.
In contrast to degenerative spondylolisthesis, managing isthmic spondylolisthesis is generally more straightforward, with fusion being necessary due to the structural instability resulting from the pars defect.
DOI: 10.25122/jml-2025-0039
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