The role of reduction in operative treatment of spondylolytic spondylolisthesis.

Isthmic spondylolisthesis is a frequently encountered spinal disorder (3-5% of the population). The latest developments in spondylo-implantology have increased interest in operative treatment of slip. The reduction of slip, however, remains controversial and is broadly discussed. On the basis of the literature, the paper presents current views on benefits and risks associated with reduction. Moreover, stabilization methods are discussed and a modified reduction procedure is presented. Spondylolisthesis reduction effectively relieves clinical complaints, and reconstitutes physiological spinal load bearing and spino-pelvic balance. Stabilization eliminates segmental instability and improves conditions for spondylodesis. Currently, one-segmental interbody stabilization with transpedicular fixation is a recommended method. Broad and complete decompression of neural elements and its control during the reduction procedure is recommended in order to avoid neurological complications. Reduction of spondylolytic spondylolisthesis seems to be a safe and effective method provided that a meticulous operative technique is followed.