RT Journal
A1 Lamberg, Tommi
A1 Remes, Ville
A1 Helenius, Ilkka
A1 Schlenzka, Dietrich
A1 Seitsalo, Seppo
A1 Poussa, Mikko
T1 Uninstrumented In Situ Fusion for High-Grade Childhood and Adolescent Isthmic Spondylolisthesis: Long-Term Outcome
JF The Journal of Bone & Joint Surgery
JO The Journal of Bone & Joint Surgery
YR 2007
FD March 1
VO 89
IS 3
SP 512
OP 518
DO 10.2106/JBJS.E.00545
UL http://dx.doi.org/10.2106/JBJS.E.00545
AB Background: Intermediate-term radiographic studies have shown that
anterior and circumferential techniques result in high fusion rates in
patients with high-grade spondylolisthesis, whereas posterolateral fusion is
less successful. We are not aware of any long-term comparative studies in
which these three methods have been evaluated with regard to functional
outcome, including systematic spinal mobility and trunk strength
measurements.Methods: Sixty-nine of eighty-three consecutive patients with
high-grade isthmic spondylolisthesis who underwent posterolateral
(twenty-one), anterior (twenty-three), or circumferential (twenty-five)
uninstrumented spondylodesis between 1977 and 1991 participated in the study.
The average duration of follow-up was 17.2 years. Radiographs that were made
preoperatively and at the time of the most recent follow-up were assessed with
regard to fusion quality and degenerative changes. Outcome was assessed at the
time of the most recent follow-up by independent observers on the basis of a
physical examination, spinal mobility and nondynamometric trunk strength
measurements, and Oswestry Disability Index scores.Results: The mean preoperative vertebral slip was 61% in the
posterolateral fusion group, 63% in the anterior fusion group, and 71% in the
circumferential fusion group. The final fusion rate was 86% (eighteen of
twenty-one) in the posterolateral fusion group, 100% (twenty-three of
twenty-three) in the anterior fusion group, and 96% (twenty-four of
twenty-five) in the circumferential fusion group. A decrease in lumbar
intervertebral disc height at the first mobile level superior to the fusion
was noted in five patients in the posterolateral fusion group, seven patients
in the anterior fusion group, and one patient in the circumferential fusion
group (p = 0.037). The mean Oswestry Disability Index score was 9.7 for the
posterolateral fusion group, 8.9 for the anterior fusion group, and 3.0 for
the circumferential fusion group (p = 0.035). Nondynamometric trunk strength
measurements corresponded with referential values. Abnormally low lumbar
flexion affected the posterolateral and circumferential fusion groups more
often than the anterior fusion group (p = 0.0015). The percentage of slip
showed inverse correlations with lumbar flexion, lumbar extension, and trunk
side-bending.Conclusions: As assessed on the basis of patient-based outcomes,
circumferential in situ fusion provided slightly better long-term results than
did posterolateral or anterior in situ fusion. When the radiographic and
functional results were combined with the patient-based outcomes, the overall
differences between the three groups were small.Level of Evidence: Therapeutic Level III. See
Instructions to Authors for a complete description of levels of evidence.