Mustafa Can KOŞAY, Eren AKIN, Rasim Haluk BERK, Emin ALICI
Journal of Turkish Spinal Surgery - 2026;37(EK-1):12-20
Spondylolysis and spondylolisthesis encompass a heterogeneous group of spinal disorders with varying etiologies, age distributions, clinical presentations, and management strategies. This narrative review was prepared in memory of Prof. Dr. Emin Alıcı, whose residency thesis and subsequent academic career were devoted to spondylolysis and spondylolisthesis, and whose early work significantly influenced the understanding and surgical management of these conditions in our institution. By integrating his foundational concepts with contemporary evidence, this review traces the evolution of knowledge from classical principles to current practice. Clinical manifestations range from mechanical low back pain to radiculopathy and neurogenic claudication, highlighting the importance of a careful clinical evaluation, supported by appropriate imaging. Standing radiographs remain essential for assessing slip severity, sagittal alignment, and pelvic parameters, while computed tomography and magnetic resonance imaging provide detailed evaluation of morphology. Traditional classification systems, such as Meyerding and Wiltse, remain widely used because of their simplicity, but they are limited in prognostic value and in guiding treatment. More recent systems, including those proposed by the French Society for spine surgery, clinical and radiographic degenerative spondylolisthesis classification, and the University of California San Francisco degenerative spondylolisthesis classification, incorporate sagittal balance, instability, and clinical symptoms, offering a more comprehensive framework for individualized treatment planning. Management strategies differ substantially between pediatric and adult populations. Conservative treatment is the first-line approach for most cases of spondylolysis and low-grade spondylolisthesis. Surgical intervention is reserved for patients with persistent pain, neurological deficits, progressive deformity, or high-grade slips. Spondylolysis and spondylolisthesis require individualized evaluation and management, grounded in an understanding of the biomechanics, natural history, and clinical presentation.
