The most common type of lumbar spine slippage is degenerative slippage. This type of slippage is caused by degenerative changes in the lumbar spine resulting in a series of symptoms and signs, such as low back pain, neurogenic pain in the lower extremities, intermittent claudication, and dysfunction of the second stool. Although clear lesion sites and corresponding pathological changes can be seen on X-ray, CT and MRI, the degree of change and the appearance of symptoms and signs are not proportional, and even slippage is obvious, but the patient has no symptoms, so lumbar spine slippage is not equal to lumbar spondylolisthesis. For lumbar spondylolisthesis, although conservative treatment cannot reset the spondylolisthesis, it can still achieve certain efficacy and relieve the symptoms. Only when the symptoms of slippage are serious and persist, and conservative treatment is ineffective, or when the neurological dysfunction is aggravated and the dysfunction of the second stool, etc. should surgical treatment be considered. 1, decompression Currently, the primary purpose of surgery for degenerative lumbar spondylolisthesis is decompression. Since degeneration and hyperplasia of the articular synovial joint play an important role in causing nerve canal stenosis and lateral saphenous fossa stenosis, decompression should focus on the lateral saphenous fossa and nerve root canal area, and nerve root decompression should be adequate. In addition, the stable structures of the spine should be protected to the maximum extent possible, and the removal of the lamina should be reduced as much as possible, so that the purpose of decompression can be achieved and the interference with the stability of the spine can be reduced. 2, stabilization of degenerative slippage generally combined with instability, decompression may be more unstable, so stability is an important step in the treatment of degenerative slippage of the lumbar spine, in general, are required for internal fixation. Internal fixation can not only achieve the purpose of stability, but also create conditions for bone graft fusion. 3, reset degenerative lumbar spondylolisthesis generally slipped lighter. At present, most experts believe that every effort should be made to reset, but for cases that have been stabilized and spontaneously fused, they should not be reset. We have found in the clinic that in some cases, even if there is no reset, the symptoms are completely relieved after surgery. We have also seen cases in which, even though the repositioning was good, the postoperative symptom relief was unsatisfactory and even new symptoms developed. In many cases, sacro-hip pain was not present preoperatively, but postoperatively, sacro-hip soreness developed. This pain tends to gradually resolve in about 1 month. There may be two reasons for this: 1) although there is no reset, it has been stabilized; 2) the patient has already adapted to the sacroiliac joint and pelvic tilt, gluteal muscles and posterior femoral muscle tension in the long-term slipped state, and has reached a state of equilibrium, so if reset breaks this equilibrium instead, it needs to re-establish the equilibrium, and this process from equilibrium to imbalance and then to equilibrium needs a process. Clinical reset must be carried out on the basis of adequate decompression, never reset without decompression. Because the pathological changes of degenerative slippage are comprehensive, if the decompression is not sufficient, the reset may cause new compression, or even the original nerve root is not subject to compression, but will be subject to compression after reset, so this situation must be avoided. 4, fusion fusion is the final purpose of treatment of slippage, internal fixation is a means to promote fusion; conversely, without fusion, internal fixation will also fail, so fusion should be given an important position. How to improve the fusion rate and maintain the stability and balance of the spine is the key to solve the problem. Lumbar isthmic fracture slippage is mostly seen in L4 and L5 segments. Due to the instability of the isthmic cleft vertebral body, secondary hypertrophy of the ligamentum flavum, disc degeneration, synovial joint hyperplasia, and sclerosis of the supraspinous ligament and interspinous collision, the dural sac is compressed, resulting in a series of symptoms and signs. However, because the disease occurs and develops slowly, the nerve roots are more tolerant to chronic compression, and the tissue tension develops gradually, so even though the degree of slippage is heavy, there are still no symptoms or very mild symptoms, especially when the lumbar spine tends to stabilize in the slipped position, the patient often has no symptoms or the symptoms are relieved. For the surgical treatment of this type, decompression and stabilization are still the first priority, while repositioning is secondary. For example, in the case of L5 slippage, the enlarged synovial joint and isthmus tissue cause compression on the L5 nerve root, while pulling on the S1 nerve root, so it may produce L5 nerve root symptoms. The surgical repositioning can relieve the S1 nerve root impingement, but at the same time, it will cause impingement on the 5th lumbar nerve root. In addition, for those with mild isthmus cleft, direct repositioning without decompression may cause new compression or aggravate the original compression, which may aggravate the symptoms, so sometimes the repositioning is good, but the symptoms are aggravated, so do not force the repositioning of lumbar spondylolisthesis. Problems faced by the pursuit of anatomical repositioning: 1. Because the completion of anatomical repositioning requires the removal of bone connections and growths between any slipped segments, very serious slippage may require one or more operations combined with anterior and posterior approaches to complete, so the operation is widely exposed, traumatic, bleeding, long operation time, high incidence of complications such as infection, nerve injury, dural injury, cerebrospinal fluid leakage and vascular injury. 2.The surgery in front of the lumbosacral region may damage the visceral nerves and develop sexual dysfunction. Lumbar 4 or lumbar 5 nerve root injury, the latter is more likely to occur, and for severe slippage, repositioning without completing complete decompression of the spinal canal including the intervertebral foramen is more likely to damage the lumbar 4 or lumbar 5 nerve roots. In conclusion, regardless of whether it is a degenerative lumbar spondylolisthesis or a lumbar isthmic cleft spondylolisthesis, decompression and stabilization is the key, and repositioning is not forced.