Lumbar Degenerative Spondylolisthesis in Adults NYC | Dr. Zeeshan Sardar

Lumbar Degenerative Spondylolisthesis in Adults in New York City

Dr. Zeeshan Sardar, MD, MSc, F.R.C.S.C
Director, Quality & Patient Safety (QPS) – Och Spine Hospital
Medical Director, Spine Unit – Och Spine Hospital
Co-Chief of Spinal Deformity Surgery • NewYork-Presbyterian / Columbia University
Och Spine Hospital • New York, NY

Degenerative spondylolisthesis is the most common form of spondylolisthesis in adults. Unlike isthmic spondylolisthesis, which results from a stress fracture, degenerative spondylolisthesis occurs when the disc and facet joints degenerate and lose their ability to restrain normal segmental motion — allowing one vertebra to slip forward on the vertebra below. It most commonly occurs at L4–L5 and is more prevalent in older adults. When it causes symptoms, it produces a characteristic combination of back pain and leg symptoms from the resulting stenosis.

SYMPTOMS

  • Lower back pain — often worse with standing and activity; relieved by sitting
  • Neurogenic claudication — leg pain, heaviness, or weakness with walking that improves with sitting or bending forward; from associated stenosis at the slip level
  • Radiculopathy — pain, numbness, or weakness in a specific nerve root distribution from foraminal stenosis
  • Progressive functional limitation — reduced walking tolerance over months to years

DIAGNOSIS

Standing X-rays (including flexion-extension views) demonstrate the slip and assess stability. MRI reveals the degree of canal and foraminal stenosis at the slip level. CT provides bony detail for surgical planning. Bone density testing is important preoperatively.

NON-SURGICAL TREATMENT

  • Physical therapy — core strengthening and flexion-based exercises
  • Epidural steroid injections — for leg pain relief
  • Activity modification and weight management

WHEN IS SURGERY INDICATED?

  • Failure of conservative treatment after 3–6 months
  • Significant functional limitation from claudication or leg pain
  • Progressive neurological deficit
  • High-grade slip (Grade II or higher) with neurological compromise

THE SURGERY: DECOMPRESSION AND FUSION

Surgical treatment involves both decompression of compressed nerve roots and fusion of the unstable segment. Decompression alone (without fusion) has been shown to be inferior to combined decompression and fusion in multiple clinical trials. The procedure is most commonly performed as a TLIF with robotic-assisted pedicle screw placement. For selected patients with mild slip, a minimally invasive approach is appropriate. The SPORT trial demonstrated durable superiority of surgery over non-operative care for symptomatic degenerative spondylolisthesis at 4-year follow-up.

RECOVERY

Hospital stay: 2–3 days for single-level. Return to light activity: 4–6 weeks. Return to sedentary work: 4–8 weeks. Return to physical work: 3–6 months. Fusion maturation: 12 months.

WHY CHOOSE DR. SARDAR

Dr. Sardar uses robotic-assisted navigation as standard for all instrumented lumbar procedures, including spondylolisthesis fusion. He offers both minimally invasive and open approaches and selects the technique that matches each patient’s anatomy, slip grade, and surgical goals.

This page is for educational purposes only and does not constitute individualized medical advice.

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