Spondylolisthesis Surgery Overview

Spondylolisthesis is a spinal condition that can cause significant back pain and numbness, tingling, or weakness in the extremities. In most cases, people with this condition recover without having to go under the knife. But, when non-surgical therapies fail, spondylolisthesis surgery may be necessary. 

In this article, we’ll provide a comprehensive overview of spondylolisthesis surgery and when to consider it for your spinal symptoms. 

How Spondylolisthesis Surgery Is Made

Spondylolisthesis surgery is done by stabilizing the spine and resolving any compression on the spinal nerves. This is known as spinal decompression. 

Stabilization in spondylolisthesis surgery may involve spinal fusion or the implantation of a non-fusion device. 

Is Spondylolisthesis Surgery a Major Surgery?

Spondylolisthesis surgery is usually a major surgery, as it’s performed under general anesthesia and may involve cutting into the back muscles to access the spine. 

However, with the latest medical advancements, minimally invasive techniques may be used in spondylolisthesis surgery. Unlike traditional spine surgery, minimally invasive spondylolisthesis surgery involves a small incision and doesn’t disrupt the back muscles or organs near the spine. 

What Is the New Surgery for Spondylolisthesis?

The new surgery for spondylolisthesis is non-fusion spinal decompression surgery. 

The non-fusion approach to spondylolisthesis surgery involves stabilizing the spine without permanently fusing the affected vertebrae. Instead, a non-fusion implant (like the TOPS System) is inserted into the spine to create a controlled range of motion. 

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The TOPS System is a mechanical implant device indicated for degenerative spondylolisthesis and spinal stenosis at the L2 to L5 spinal levels. In June 2023, the FDA approved TOPS for these conditions and granted the device a superiority-to-fusion claim. 

What Is the Success Rate for Spondylolisthesis Surgery?

The success rate of spondylolisthesis surgery ranges from 70% to 88%, depending on the procedure and the severity of the condition.   

The TOPS System for spondylolisthesis had an overall success rate of 76.7% in a clinical study of 115 people who reached two years of follow-up.  

What Affects the Success Rate of Spondylolisthesis Surgery?

Many factors may be considered in the success rate of spondylolisthesis surgery, including:

  • Decreased pain: A key determinant in the success rate of a spondylolisthesis procedure is pain relief. To be considered successful, the surgery must provide a lasting, significant improvement in pain and other spondylolisthesis symptoms, like tingling, numbness, and weakness in the extremities. 
  • Increased function: Similarly, a successful spondylolisthesis surgery must improve the patient’s ability to complete daily tasks and participate in various activities. 
  • Rate of complications: A low rate of complications indicates that surgery is successful. Some of the possible complications of spondylolisthesis procedures include nerve injury, chronic pain, infection, hardware failure, fusion failure, and blood clots. 
  • Patient satisfaction: Patient satisfaction is an important factor to consider when contemplating surgery for spondylolisthesis. 

What’s the Rate of Complications in Spondylolisthesis Surgery?

The rate of complications in lumbar spinal fusion surgery can vary from 29% to 62%. The TOPS System for spondylolisthesis had a complication rate of 7.2% in a prospective study. 

Is Surgery Worth It for Spondylolisthesis?

Surgery may be worth it for spondylolisthesis if your symptoms are inhibiting your daily activities and compromising your quality of life. 

Additionally, surgery is often worthwhile for spondylolisthesis in patients who haven’t responded to non-surgical therapies, like:

  • Physical therapy
  • Chiropractic care
  • Pain medications
  • Bracing
  • Corticosteroid injections

Signs That Spondylolisthesis Surgery May Be Worth it For You

Spondylolisthesis may be worth it for you if:

  • You’re still experiencing moderate to severe spondylolisthesis symptoms after six to 12 months of conservative treatment. 
  • You have to significantly modify your daily activities to accommodate spondylolisthesis symptoms. 
  • You’re unable to work or complete essential daily tasks because of spondylolisthesis. 
  • Spondylolisthesis has severely compromised your quality of life. 

Is Spondylolisthesis Surgery Safe?

Spondylolisthesis surgery with clinically proven procedures is considered safe for qualifying patients. 

To ensure the safety of spondylolisthesis surgery, it’s essential to choose a qualified spinal surgeon. Look for the following qualifications:

  • A license to practice in your state 
  • A college degree including premedical education, medical school, and residency in orthopedic surgery or neurosurgery
  • A board certification in orthopedic or neurological surgery
  • A fellowship in spinal surgery

Additionally, make sure that:

  • The surgeon’s practice is largely focused on spinal surgery
  • The surgeon has earned many positive online reviews
  • The surgeon can provide testimonials from patients who have undergone the same procedure
  • The surgeon can clearly outline the procedure, required downtime, risks, and possible complications of the surgery
  • The surgeon provides realistic expectations for the results of the procedure, rather than claiming to be able to “cure” you

What Is the Age Limit for Spinal Surgery?

There’s no set age limit for spinal surgery. However, your surgeon will consider your age before recommending surgery for spondylolisthesis. 

Younger patients with spinal conditions have a higher risk of reoperation than older patients. This is because they may outlive the hardware’s lifespan, and hardware failure can lead to complications. Thankfully, younger patients rarely require spondylolisthesis surgery and usually recover with non-surgical therapies. 

On the other hand, elderly patients often face a higher risk of surgical complications due to underlying conditions. Seniors must be in good general health to safely undergo major spinal surgery. 

The TOPS System is indicated for patients between the ages of 35 and 80 with degenerative spondylolisthesis. 

What Happens if You Don’t Fix Spondylolisthesis?

If you don’t fix spondylolisthesis, you may experience chronic back pain and complications from permanent spinal damage. 

Possible complications of untreated spondylolisthesis include:

Spinal Stenosis

Without prompt treatment, spondylolisthesis can cause spinal stenosis. Spinal stenosis is another spinal condition involving the narrowing of the spinal canal. It often causes neurological symptoms like numbness, tingling, and weakness. 


In severe cases, untreated spondylolisthesis can lead to permanent nerve damage, which can lead to cauda equina syndrome and paralysis. Cauda equina syndrome develops when the group of nerves and nerve roots at the bottom of the spinal cord becomes compressed. These nerves supply sensory function to the legs, bladder, anus, and perineum. 

If you experience signs of cauda equina syndrome, seek emergency medical care to prevent permanent paralysis. Warning signs of this condition include:

  • Urinary retention (not feeling the urge to urinate, despite having a full bladder)
  • Numbness of the buttocks, upper inner thighs, genitals, and perineum 
  • Weakness or paralysis of the lower extremities
  • Bladder or bowel incontinence
  • Sexual dysfunction

Spinal Deformities

Left untreated, spondylolisthesis can cause spinal deformities, like a round back or swayback, over time. These deformities can accelerate spinal degeneration and increase your risk of developing other spinal conditions. 

What Is the Best Choice for Spondylolisthesis Surgery?

The best choice for spondylolisthesis is generally minimally invasive spinal decompression with non-fusion stabilization. This can be achieved with the TOPS System, as mentioned above. 

Rather than permanently fusing the vertebrae, the TOPS System restores a controlled range of motion in the spine. It allows the spine to move in all directions, unlike spinal fusion but resolves the instability associated with spondylolisthesis. Additionally, the TOPS System replaces the soft and bony tissues removed during the decompression procedure, providing relief from pain and neurological symptoms. 

The TOPS System is FDA-approved for degenerative spondylolisthesis and spinal stenosis between the L2 to L5 segments of the lumbar spine. To learn if you’re a candidate for this modern form of spondylolisthesis surgery, find a licensed surgeon in your area today.