The Natural History of Isthmic Spondylolisthesis: A Scoping Review

Purpose : Isthmic spondylolisthesis commonly develops during childhood or adolescence. Many individuals remain asymptomatic or clinically stable, uncertainty persists regarding slip progression and the likelihood of requiring surgical intervention. This has led to variability in follow-up strategies and treatment thresholds. A clear synthesis of the existing literature is required to better inform prognosis and shared decision-making. Research Question : What is the natural history of isthmic spondylolisthesis with respect to radiographic progression, clinical outcomes, and progression to surgical intervention? Methods : A comprehensive literature search of PubMed, Embase, and Scopus was performed up to April 2025 in accordance with PRISMA-ScR guidelines. Studies examining the natural history of lumbar isthmic spondylolisthesis in paediatric or adult populations and reporting radiographic, clinical, or surgical outcomes were included. Data extraction was conducted using Covidence. Results : Eleven observational studies met inclusion criteria, with sample sizes ranging from 5 to 311 participants, mean ages between 4 and 62 years, and follow-up durations of up to 45 years. Radiographic progression was minimal after skeletal maturity, with true progression (>20%) occurring in a minority, commonly during periods of rapid growth. Symptoms were stable or improved in most cohorts, and pain demonstrated poor correlation with radiographic progression. Rates of surgical intervention varied widely (0–70%). Conclusions : The natural history of paediatric isthmic spondylolisthesis is predominantly stable, with a low likelihood of clinically significant progression. Conservative management remains effective for most patients. Future studies incorporating spinopelvic parameters, skeletal maturity assessment, and validated patient-reported outcomes are needed to refine risk stratification and optimise long-term management.