There is a technique with transisthmal screws. But the 360 degrees fusion is my choice. That is to say combined anterior and posterior fusion.

L5/S1 spondylolisthesis up to grade 2 in a young person usually can be treated non-operatively. I have found isthmic L3/L4 spondylolisthesis in an active young person , resistant to non operative treatment. I would advise fusion with pedicle screws L3 to L4 with an interbody fusion (TLIF)

Dear Dr. Gorodetzky, 

You mention rupture of isthmus. Is it an acute trauma ? Or not ?  If yes, this a traumatic spondylolisthesis and not isthmic. Spondylolysis is pathology that in a greater part of the patients is a result of trauma but a repeating microtrauma in children and adolescents. For example in gymnasts.

The L3 isthmus defect with L3-L4 spondylosithesis is much less frequent than in the lower lumbar segments. Regardless of the etio-pathogenesis of the defect, if the instability is symptomatic, the only choice of treatment is surgical stabilization. In my experience of more than 15 cases in the last three years, I have had excellent results with a relatively new  less invasive procedure (eXtreme Lateral Interbody Fusion and posterior fixation with percutaneous pedicle screwing). The procedure is truly minimally invasive and patient experiences an immediate comfortable feeling of stability of the spine

would agree that XLIF followed by minimally invasive posterior fixation, in experienced hands , is a good alternative to Posterior fusion and TLIF

Mis-aligned fracture = Chance Fracture? What is the mechanism? What is the neurology? Are there any images? This need to be clear for a proper answer.

High (mid lumbar) spondylolysis/spondylolisthesis is rare, and I have only sen a few. But they have been in people very active in sports such as gymnastics and baseball here in the US. I don't know if there is a pelvic incidence range that predisposes them as there is with L5/S1 spondys. While there is concern about creating a "floating fusion"segment in a young patient, I have not had success with nonoperative care.

If surgery is decided on, I think sagittal balance is critical so i would plan preoperatively with surgimap and use prebent rods (UNiD)

Dear colleagues, 

I already noticed that the data presented for the history (acute trauma or not ?), pathomechanism, type of spondylolisthesis, degeree of spondylolisthesis, neurologic deficit, etc. are insufficient for a proper advice. Sorry.

I agree completely with Prof  Tanchev. This is why I placed all these questions previously. Hope to be answered.

Dimitry has asked a key question- is there a non operative treatment. The answer to that would depend on whether the lesion is acute and traumatic or a recently detected stress injury. In this event a non operative treatment can sometimes be successful. If it is a long standing developmental disorder, as it most often is, it is best treated surgically. I would personally make the decision of what type of surgery to do based on the grade of slip and the status of the disc on MRI scan. If the slip is grade 1 or less and the disc is intact I would chose to do the "pars repair surgery" by the minimally invasive approach. This technique was originally meant for the adolescent lysis cases but I now have experience with young adults as well and the results are very gratifying. I would chose the 360 degree fusion techniques (which ever approach is chosen) for higher grades of slips and  for degenerate discs at the affected level. I hope Dimitry  we have answered all Dimitry's queries.

In any case  laminectomy as an only procedure without fusion is a bad idea. Independent from the missing data.This may be taken for certain.

If spondylolisthesis is symptomatic the best treatment is fusion, I agree that laminectomy alone is not a good idea.

I prefer a pars repair surgery with pedicle screw and hook if she or he  has no disc degeneration on MRI, and after the fusion  is completed, the implants should be removed.    If isthmic slip has already developed, TLIF or PLIF  using the resected lamina maybe be better.