This narrative review outlines surgical indications, technique selection, and complication management for spondylolysis and spondylolisthesis in children and adolescents, covering the spectrum from pars repair in low-grade slips to instrumented reduction in high-grade deformity.
When a skeletally immature patient fails 6–12 months of conservative care: use in situ fusion for L5 pars defects, pars repair for defects above L5 or at multiple levels, and reserve instrumented reduction for high-grade slips with slip angle >45° or severe sagittal imbalance — but stop at grade II residual translation to keep L5 nerve strain in the safe half of the reduction arc.
This narrative review outlines surgical indications, technique selection, and complication management for spondylolysis and spondylolisthesis in children and adolescents, covering the spectrum from pars repair in low-grade slips to instrumented reduction in high-grade deformity.
When a skeletally immature patient fails 6–12 months of conservative care: use in situ fusion for L5 pars defects, pars repair for defects above L5 or at multiple levels, and reserve instrumented reduction for high-grade slips with slip angle >45° or severe sagittal imbalance — but stop at grade II residual translation to keep L5 nerve strain in the safe half of the reduction arc.