We prefer standing myelography followed by CT for multilevel stenosis and stenosis accompanied by deformity. A rational regimen would include gentle physical therapy with an emphasis on lumbar stabilization in neutral posture and spinal muscle strengthening, anti-inflammatory medication, periodic epidural steroid injection, and a lightweight corset or brace in neutral position.13 Bedrest, percutaneous diskectomy, and chemonucleolysis have no role in the management of spinal stenosis.6 Surgical indications consist of intractable pain with major quality of life impairment and profound neurologic deficit. Age is not a contraindication to surgery, but the patient's general medical condition must be considered.12 Decompression alone is usually done for stable, central forms of degenerative spinal stenosis, while stabilization through fusion is added for unstable spinal stenosis. Extreme lateral recess decompression or facetectomy may create instability or potential instability, necessitating fusion. Symptoms include both back pain and radicular symptoms, usually in an L-5 distribution.
Plain films show the olisthy and facet sclerosis without a pars interarticularis defect.
Myelography-CT reveals an hourglass constriction, with obliteration of the lateral recesses. Surgical treatment consists of both decompression and fusion. Decompression alone may transiently relieve symptoms of neural compression. However, further posterior destabilization may lead to continued mechanical back pain, as well as progression of the slippage. Herkowitz and Kurz,17 in a randomized prospective study, found a statistically significant improvement in patients treated by decompression and fusion, as opposed to decompression alone, for degenerative lumbar spondylolisthesis.