Spondylolisthesis refers to a condition where one vertebra slides over its adjacent vertebra, causing pain and pressure on the connecting nerves in the area. In this case, the upper vertebra moves back and forth in relation to the next consecutive vertebra. There are many types of spondylolisthesis, with some of them being more common than others. 

Some cases of spondylolisthesis may require surgery, while others can be controlled with physical therapy, pain management, and other non-surgical techniques. The requirement for spondylolisthesis surgery depends on the stage of progression of the disease. To understand this better, let’s take a look at how spondylolisthesis is diagnosed. 

How is Diagnosis and Grading of Spondylolisthesis Done?
In most cases, the diagnosis of spondylolisthesis cannot be done by just examining a patient. Lateral X-ray scans are used to see if the vertebrae have slipped over one another. Then the doctor grades the progression of the disease using the percentage of slip that has occurred. These are the criteria by which spondylolisthesis is graded: 

Grade I - Slippage up to 25%
Grade II - Slippage ranging from 26% to 50%
Grade III - Slippage ranging from 51%-75%
Grade IV - Slippage Ranging from 75% to 100%
Grade V - One or more vertebrae have fallen off their adjacent vertebra

Unless the spondylolisthesis has reached a point where it is unmanageable by the patient, or the vertebrae continue sliding over one another, surgery is not considered. Also, it has been recommended by the American Academy of Orthopaedic Surgeons to try nonsurgical treatments thoroughly before opting for traditional surgery. 

In case surgery is essential for the wellbeing of the patient, then the main goal of spondylolisthesis surgery is to minimize pain and alleviate pressure on the nerve roots in the spinal cord. This process involves decompression, spinal fusion, pars repair, and other techniques. 

But often, the question arises - “Is it really safe to get a spondylolisthesis surgery?”. The answer to this question depends on several different factors which are clarified in the next section. 

Complications and Risks of Spondylolisthesis Surgery
With any form of surgery on the body, there are risks of some general compilations that may occur. These complications can occur more in the case of delicate surgeries like this one. 

Some of the problems could include the need for additional surgeries, and some could be even more serious, like impairment, infections, or chronic pain. The several complications have been listed below along with brief details on them. 
Note that this list is not a substitute for discussing and managing expectations with your surgeon and doctor, and should only be used as a reference. First, let’s start off with the general risks that every surgery entails, and the probability of them occurring during spondylolisthesis surgery. 

Anesthetic Complications
Most surgeries require the patient to be administered with some form of anesthesia to keep them unconscious during the procedure. In the case of small to moderate and localized surgeries, local anesthesia is used. 

Spondylolisthesis surgery is usually much more complex and requires general anesthesia to be administered to the patient. The body is completely unconscious during this process and requires special breathing apparatus to regulate oxygen throughout the body. Also, problems can arise from other medications or pathological problems in the patient. Make sure to discuss the details and chances of problems during the procedure with an anesthesiologist. 

Breathing Complications
After surgery, the lungs don’t work too well because of medications used during local anesthesia along with some other factors. Also, due to the lack of movement and pain medications, the patient can breathe slower than usual, which leads to the lack of enough oxygen in the body.

The tissues in a body depend upon a steady flow of oxygen in order to repair themselves. People who smoke or have other lung problems can run into complications after the surgery. Often these are discussed by the surgeon before the surgery, and should not pose a serious problem in most cases. 

With all surgeries, there is a very slight chance of infection. Infections are extremely rare in the case of spinal surgeries, with a chance of just 1%. But, if you notice redness or swelling around the surgical wound, then it can be a sign of an infection. To avoid these problems, antibiotics are administered during and after the surgeries. 

Superficial wounds between the layers of the skin can be treated with normal antibiotics and ointments, but deep internal wounds are more serious can may require subsequent operations to clear up. In very serious cases, the implants attached during the surgery may need to be removed. 

Migration of Implants
In these cases, the implants get displaced from their initial position. If this were to occur, it happens fairly soon after the surgery procedure. If the implant gets displaced too much, then it won’t be able to stabilize the connected vertebrae and can lead to pressure on other tissues and nerves. 

Also, if the implants put pressure on the spinal cord or large vessels, it can lead to even more damage. In the rare case that this happens, a diagnosis is made with X-rays, and another surgery is done to put the implants in the right place.

Spinal Cord Injuries
Operating on the spine can be risky because of the close proximity to the spinal cord. This is a delicate structure of a column of nerves that connects the brain to the rest of the body. The nerves have a branched structure originating from the spinal cord. 

Damage to this structure during the surgery is exceptionally rare as this procedure is done by highly qualified professionals. But, in case it does occur, the patient may be paralyzed according to the nerves which were damaged. 

Chronic Pain
The few spondylolisthesis operations that are unsuccessful without any other serious complications may lead to persistent pain. This is usually the most common complication that can happen in spondylolisthesis surgery and can even lead to increased pain at the spot in some cases. 

You can always discuss the risks of chronic pain and the level of relief that you will get from the surgery with your doctor before proceeding. Also, pain right after the surgery is not a sign of chronic pain, as it is just a result of the healing of the tissue.

Final Words
Getting a spondylolisthesis surgery can seem daunting. But in most cases, they have helped individuals to get great relief from constantly worsening pain. Every surgery can have complications, but major surgeries like these do carry some risks with them.

Nonsurgical methods are usually recommended to the patients before surgery, as these usually work just as well to keep the pain in control and help the patient to maintain an active lifestyle. Overall, the best idea is to discuss any risk with a doctor or surgeon, and then proceed if the risks are negligible in contrast to the benefits.