Spondylolisthesis Surgery

Spondylolisthesis is a condition in which one vertebra slides forward over the vertebra below it. This anterior slippage occurs most often in the lumbosacral area (lower back).

The bones in your spinal cord, called facet joints, line up to support the spinal cord but also allow the back to move and be flexible. Spondylolisthesis occurs when one or more of the facet joints allows a vertebral bone to move out of line.

Why Is Spondylolisthesis Surgery Done

There are different types of spondylolisthesis as well as different grades of spondylolisthesis. The first three below are the most common forms.

Congenital Spondylolisthesis – this type is present at birth and is the result of abnormal bone formation that puts the vertebrae at greater risk for slipping.

Isthmic Spondylolisthesis – this type occurs in a patient with spondylolysis, a condition that causes small bone fractures in the vertebrae. These fractures can weaken the vertebrae so much that is slips out of place.

Degenerative Spondylolisthesis – a part of the normal aging process, this is the most common type of spondylolisthesis. As you age, your discs become less spongy and lose their ability to resist movement by the vertebrae, which means they are more likely to slip.

Other forms of Spondylolisthesis include:

Traumatic spondylolisthesis – when an injury causes a spinal fracture or slippage.

Pathological spondylolisthesis – when the spine is weakened by disease, infection, or tumor.

The Meyerding Grading System is used to classify the degree of vertebral slippage. Slips are graded on the percentage that one vertebral body has slipped over the vertebral body below it.

  • Grade I: 1-24%
  • Grade II: 25-49%
  • Grade III: 50-74%
  • Grade IV: 75%-99%
  • Grade V: Complete slip (100%), known as spondyloptosis

When determining if a surgical procedure is required, doctors take into consideration the degree of slip, as well as other factors such as neurological symptoms and pain. As a general rule, slips rated at Grade III and above will most likely require surgery.

Although spondylolisthesis is not the same as a bulging disc or herniated disc, the conditions can coexist. Degenerative spondylolisthesis can also cause foraminal narrowing and spinal stenosis.

Many people with spondylolisthesis have no symptoms and the disorder is discovered when seeing a doctor for other health issues. Some of the spondylolisthesis symptoms may include:

  • Mild to severe lower back pain
  • Sciatica and muscle spasms
  • Leg weakness or tingling
  • Back stiffness
  • Tight hamstrings
  • Irregular gait or limp

Surgery Options

Decompression surgery may be an option if you have tried conservative treatments but are still experiencing limited mobility and pain. The Bonati Spine Procedures offer an array of procedures to treat spondylolisthesis which may include:


A discectomy is performed to remove part of a bulging or herniated disc pressing on the spinal cord and/or spinal nerve roots, causing pain, radiculitis (pain that radiates to the extremities), numbness, tingling or weakness.


The Bonati Laminectomy/Laminotomy are decompression surgeries that relieve pressure on spinal nerves caused by narrowing of the spinal canal. The procedures are performed incrementally, one vertebral level at a time, to address the main cause(s) of pain first. A small incision is made through which a series of tubes, patented by Dr. Bonati, are inserted. The lamina is then accessed and small portions of the anterior or posterior lamina responsible for the nerve pressure are removed. Bone spurs may also be removed.


The Bonati Foraminotomy/Foraminectomy is performed to relieve pressure on compressed nerves at the site of the intervertebral foramina (neural foramen). The Bonati Foraminotomy involves a very small incision through which the patented Bonati tube system is inserted to view the surgical area using endoscopic assistance. Instrumentation is passed through the tubular system to remove the small portion of bone or disc material compressing the nerve(s).

Facet Thermal Ablation

The Bonati Facet Thermal Ablation (Rhizolysis) uses a laser to deaden sensory nerves that are irritating the facet joints and causing pain. During the procedure, our spine surgeons vaporize irritated and painful nerves around the facets of the vertebrae. Dilating Tubes and Laser are utilized to remove pain-inducing tissue in nerve branches above and below the affected facet joints on the spine.

Who Performs the Procedures?

One of the highly skilled Bonati spine surgeons will perform your procedure. All of the surgeons at The Bonati Spine Institute have trained extensively with Dr. Alfred Bonati. For more than 30 years, the surgeons at the Bonati Spine Institute have been considered leaders in advanced spine surgery techniques.

Before Surgery

Your surgeon will give you detailed instructions on how to prepare for your surgery. General guidelines include no food or drink after midnight the day before your surgery. Regular exercise can improve your recovery rate. If you are a smoker, try to quit, at least temporarily, before your surgery.

Some prescription medicine can increase your risk of bleeding and other complications during any surgical procedure. Your physician will give you specific instructions about any medications you take regularly. If you take any of the following medications, discuss with your surgeon whether or not you should take them before surgery.

  • Aspirin, Plavix, and other blood thinners
  • Anti-coagulants
  • NSAIDs such as Ibuprofen, Aleve, Naproxen, and Advil
  • Arthritis medications
  • Vitamins and herbal medicines as they may interact with the anesthesia

Discuss all of your prescription medications with your surgeon for exact instructions on how to manage them before and after surgery.

During Surgery

The Bonati Spine Procedures do not use general anesthesia. Patients are made comfortable through the use of conscious IV sedation and local anesthesia so that they are responsive and able to provide feedback throughout the procedure. This allows our surgeons to target the source of pain with pinpoint accuracy. While in the operating room, the surgical team will confirm the patient is able to complete a series of mobility exercises and verify that the pain has been successfully treated.

After Surgery

After the procedure, the patient is transferred to the post-operative care unit for rest and observation, and then a post-operative consultation with the surgeon will help determine if any additional procedures are necessary. Follow-up surgeries are usually scheduled within a few days of the first surgery, to allow any swelling to subside. During this time, the patient will be given a regimen of walking therapy.

Recovery Time from Spondylolisthesis Surgery

The Bonati Procedures are completed using small incisions. This approach helps minimize scarring and nerve injury as well as reduces recovery time. Recovery time depends on the surgery and can vary from patient to patient, but is usually within days.

More than 60,000 the Bonati Spine Procedures have been successfully performed with a patient satisfaction rate of 98.75%.