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fort to validate a surgical procedure with respect to its outcome. This is very important. However, this study was done on a limited number of patients (n=12), with a follow-up of slightly more than 2 years. The inclusion criteria for this study covered only low-grade isthmic spondylolisthesis with less than 50% slip. This group has shown in all surgical procedures in the past to be the one with the most favourable outcome. Therefore, the reader should be aware that in low-grade spondylolisthesis, as the authors mentioned, conservative treatment is the first option. Only if this fails should surgery be considered, and one treatment option might be posterior fusion with a pedicle screw device anterior cage. Non-instrumented techniques and posterior pedicle screw fixation with anterior bone graft should also be considered. REVIEWER’S COMMENT Eur Spine J (2002) 11 :434 DOI 10.1007/s00586-002-0402-1

european spine journal

Comment on "Posterior reduction and anterior lumbar interbody fusion in symptomatic low-grade adult isthmic spondylolisthesis: short-term radiological and functional outcome" by P. G. Anderson et al.