Degenerative spondylolisthesis (DS) is a complex condition characterized by the forward slipping of a lumbar vertebra with an intact posterior arch. It can be asymptomatic and thus not require any treatment, or it can cause a wide spectrum of symptoms including low back pain, radicular pain, or both.

Surgical treatment of degenerative spondylolisthesis includes simple decompression, simple fusion, or decompression plus fusion. The latter, in recent years, has been considered the treatment of choice of DS since several studies have shown that higher percentages of satisfactory results are reported when fusion is added to decompression (1,2,3,4,5,6). Although it is certainly true that, overall, fusion increases the percentages of satisfactory results in patients with this condition, it is the author’s opinion that the surgical treatment of DS should vary according to the clinical and radiologic findings and that simple decompression should be considered a possible option in selected patients with DS. The rationale for this assumption is based on several findings: (a) early studies showed that high percentages of patients submitted to simple decompression reported satisfactory results (7,8); (b) after decompression and fusion, high percentages of satisfactory results were also reported by patients with pseudarthrosis (4,5,6,7,8,9) probably meaning that decompression, rather than fusion, was the necessary treatment in these patients; (c) it is widely reported that fusion increases the perioperative and postoperative morbidity, operative time, need for blood transfusion, and risks for degenerative changes at adjacent levels (10,11). Therefore, if there are patients with DS for whom simple decompression may be successful, to add fusion should be considered an overtreatment. Last, and possibly most important, a manifest spinal instability, which requires fusion, is not always present in DS.