Long-term outcome in 132 consecutive patients after posterior internal fixation and fusion for Grade I and II isthmic spondylolisthesis

Restricted access

Object. The authors assessed the late outcome of patients with Meyerding Grade I and II isthmic spondylolisthesis (IS) who underwent posterior instrumentation and posterolateral fusion (PLF). Decompression and posterior internal fixation with PLF is the classic surgical treatment for painful low-grade IS. Nevertheless, outcome data are scarce and of limited value mainly because they represent small numbers of patients, short follow-up periods, or both.

Methods. The authors obtained data in the cases of 132 consecutive adult patients (mean age 40.6 years, range 15.2–69.9 years) with IS who underwent treatment between 1984 and 2003. Assessment involved analysis of responses to mailed questionnaires, clinical charts and, in cases in which unsatisfactory results were suspected, results of clinical reevaluations. Spondylolisthesis was present at L3–4 in three patients, L4–5 in 14, L3–4 in one, L3–5 in one, L5—S1 in 113, and S1–2 in one. Signs and symptoms included back and leg pain (65.3%), leg pain alone (26.3%), back pain alone (8.4%), and neurological dysfunction (18%).

At a mean follow-up duration of 9.9 years (range 0.5–19.4 years), favorable results were reported for back and leg pain in 91.7 and 87.1% of patients, respectively. The mean visual analog scale scores were 2.13 for back and 1.59 for leg pain. Eighty-four patients resumed full- or part-time work, and 56.8% were capable of performing housework more easily. In 45.5% of the patients analgesic medications were not required, and 43.9% required them sporadically. The majority (63.6%) of patients reported they would undergo surgery again and recommended it to others. Thirteen (9.9%) suffered adjacent-segment morbidity, and in seven (5.3%) pseudarthrosis was documented. There were two deep and one superficial infections (2.3%).

Conclusions. Posterior instrumentation and PLF, with possible neurodecompression, yielded favorable long-term results in this retrospective study of 132 patients with low-grade IS.

Article Information

Address reprint requests to: Thomas-Marc Markwalder, M.D., Neurosurgeon FMH, Thunstrasse 160, CH-3074 Muri-Bern, Switzerland. email thomasmarc.markwalder@bluewin.ch.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Bar graphs demonstrating results after surgery for back pain (upper) and leg pain (lower).

  • View in gallery

    Bar graphs demonstrating effects of surgery on use of analgesic medication (upper) and feasibility of housework (lower).

  • View in gallery

    Responses to the question, Would you undergo the same surgery again?

  • View in gallery

    Responses to the question, Would you recommend the same surgery to others?

  • View in gallery

    Bar graphs showing distributions of VAS scores for back pain (upper) and leg pain (lower).

References

1.

Carragee EJ: Single-level posterolateral arthrodesis, with or without posterior decompression, for the treatment of isthmic spondylolisthesis in adults. A prospective, randomized study. J Bone Joint Surg Am 79:117511801997Carragee EJ: Single-level posterolateral arthrodesis with or without posterior decompression for the treatment of isthmic spondylolisthesis in adults. A prospective randomized study. J Bone Joint Surg Am 79:1175–1180 1997

2.

Cotrel YDubousset J: [A new technic for segmental spinal osteosynthesis using the posterior approach.] Rev Chir Orthop Reparatrice Appar Mot 70:4894941984 (Fr)Cotrel Y Dubousset J: [A new technic for segmental spinal osteosynthesis using the posterior approach.] Rev Chir Orthop Reparatrice Appar Mot 70:489–494 1984 (Fr)

3.

Cotrel YDubousset JGuillaumat M: New universal instrumentation in spinal surgery. Clin Orthop 227:10231988Cotrel Y Dubousset J Guillaumat M: New universal instrumentation in spinal surgery. Clin Orthop 227:10–23 1988

4.

Deguchi MRapoff AJZdeblick TA: Posterolateral fusion for isthmic spondylolisthesis in adults: analysis of fusion rate and clinical results. J Spinal Disord 11:4594641998Deguchi M Rapoff AJ Zdeblick TA: Posterolateral fusion for isthmic spondylolisthesis in adults: analysis of fusion rate and clinical results. J Spinal Disord 11:459–464 1998

5.

Gill GGManning JGWhite HL: Surgical treatment of spondylolisthesis without spine fusion; excision of the loose lamina with decompression of the nerve roots. J Bone Joint Surg Am 37:4935201955Gill GG Manning JG White HL: Surgical treatment of spondylolisthesis without spine fusion; excision of the loose lamina with decompression of the nerve roots. J Bone Joint Surg Am 37:493–520 1955

6.

Huskisson EC: Measurement of pain. Lancet 2:112711311974Huskisson EC: Measurement of pain. Lancet 2:1127–1131 1974

7.

Kim NHLee JW: Anterior interbody fusion versus posterolateral fusion with transpedicular fixation for isthmic spondylolisthesis in adults. A comparison of clinical results. Spine 24:8128171999Kim NH Lee JW: Anterior interbody fusion versus posterolateral fusion with transpedicular fixation for isthmic spondylolisthesis in adults. A comparison of clinical results. Spine 24:812–817 1999

8.

La Rosa GConti ACacciola FCardali SLa Torre DGambadauro NMet al: Pedicle screw fixation for isthmic spondylolisthesis: does posterior lumbar interbody fusion improve outcome over posterolateral fusion? J Neurosurg (Spine 2) 99:1431502003La Rosa G Conti A Cacciola F Cardali S La Torre D Gambadauro NM et al: Pedicle screw fixation for isthmic spondylolisthesis: does posterior lumbar interbody fusion improve outcome over posterolateral fusion? J Neurosurg (Spine 2) 99:143–150 2003

9.

Louis R: Fusion of the lumbar and sacral spine by internal fixation with screw plates. Clin Orthop 203:18331986Louis R: Fusion of the lumbar and sacral spine by internal fixation with screw plates. Clin Orthop 203:18–33 1986

10.

Louis R: Reconstitution isthmique des spondylolyses par plaque vissée et greffes sans arthrodèse: à propos de 78 cas. Rev Chir Orthop Reparatice Appar Mot 74:5495551988Louis R: Reconstitution isthmique des spondylolyses par plaque vissée et greffes sans arthrodèse: à propos de 78 cas. Rev Chir Orthop Reparatice Appar Mot 74:549–555 1988

11.

Louis RMaresca C: Stabilisation chirurgicale avec réduction des spondylolysis et des spondylolisthésis. Int Orthop 1:2152251977Louis R Maresca C: Stabilisation chirurgicale avec réduction des spondylolysis et des spondylolisthésis. Int Orthop 1:215–225 1977

12.

Madan SBoeree NR: Outcome of posterior lumbar interbody fusion versus posterolateral fusion for spondylolytic spondylolisthesis. Spine 27:153615422002Madan S Boeree NR: Outcome of posterior lumbar interbody fusion versus posterolateral fusion for spondylolytic spondylolisthesis. Spine 27:1536–1542 2002

13.

Markwalder TM: The unstable lumbar spine. Indications for internal fixation and fusion with practical biomechanical considerations with respect to implant choice. Rivista di Neuroradiologia 12 (Suppl 1):1411561999Markwalder TM: The unstable lumbar spine. Indications for internal fixation and fusion with practical biomechanical considerations with respect to implant choice. Rivista di Neuroradiologia 12 (Suppl 1):141–156 1999

14.

Markwalder TMReulen HJ: Diagnostic approach in instability and irritative state of a “lumbar motion segment” following disc surgery—failed back surgery syndrome. Acta Neurochir 99:51571989Markwalder TM Reulen HJ: Diagnostic approach in instability and irritative state of a “lumbar motion segment” following disc surgery—failed back surgery syndrome. Acta Neurochir 99:51–57 1989

15.

Markwalder TMSaager CReulen HJ: “Isthmic” spondylolisthesis—an analysis of the clinical and radiological presentation in relation to intraoperative findings and surgical results in 72 consecutive cases. Acta Neurochir 110:1541591991Markwalder TM Saager C Reulen HJ: “Isthmic” spondylolisthesis—an analysis of the clinical and radiological presentation in relation to intraoperative findings and surgical results in 72 consecutive cases. Acta Neurochir 110:154–159 1991

16.

Markwalder TMWenger MElsig JPLaloux E: The Wilhelm Tell technique for anterior lumbar interbody fusion. J Neurosurg (Spine 2) 98:2222252003Markwalder TM Wenger M Elsig JP Laloux E: The Wilhelm Tell technique for anterior lumbar interbody fusion. J Neurosurg (Spine 2) 98:222–225 2003

17.

McGuire RAAmundson GM: The use of primary internal fixation in spondylolisthesis. Spine 18:166216721993McGuire RA Amundson GM: The use of primary internal fixation in spondylolisthesis. Spine 18:1662–1672 1993

18.

Meyerding HW: Spondylolisthesis: surgical treatment and results. Surg Gynecol Obstet 54:3713771932Meyerding HW: Spondylolisthesis: surgical treatment and results. Surg Gynecol Obstet 54:371–377 1932

19.

Miyakoshi NAbe EShimada YOkuyama KSuzuki TSato K: Outcome of one-level posterior lumbar interbody fusion for spondylolisthesis and postoperative intervertebral disc degeneration adjacent to the fusion. Spine 25:183718422000Miyakoshi N Abe E Shimada Y Okuyama K Suzuki T Sato K: Outcome of one-level posterior lumbar interbody fusion for spondylolisthesis and postoperative intervertebral disc degeneration adjacent to the fusion. Spine 25:1837–1842 2000

20.

Möller HHedlund R: Instrumented and noninstrumented posterolateral fusion in adult spondylolisthesis—prospective randomized study: part 2. Spine 25:171617212000Möller H Hedlund R: Instrumented and noninstrumented posterolateral fusion in adult spondylolisthesis—prospective randomized study: part 2. Spine 25:1716–1721 2000

21.

Nooraie HEnsafdaran AArasteh MM: Surgical management of low-grade lytic spondylolisthesis with C–D instrumentation in adult patients. Arch Orthop Trauma Surg 119:3373391999Nooraie H Ensafdaran A Arasteh MM: Surgical management of low-grade lytic spondylolisthesis with C–D instrumentation in adult patients. Arch Orthop Trauma Surg 119:337–339 1999

22.

Ricciardi JEPflueger PCIsaza JEWhitecloud TS III: Transpedicular fixation for the treatment of isthmic spondylolisthesis in adults. Spine 20:191719221995Ricciardi JE Pflueger PC Isaza JE Whitecloud TS III: Transpedicular fixation for the treatment of isthmic spondylolisthesis in adults. Spine 20:1917–1922 1995

23.

Schnee CLFreese AAnsell LV: Outcome analysis for adults with spondylolisthesis treated with posterolateral fusion and transpedicular screw fixation. J Neurosurg 86:56631997Schnee CL Freese A Ansell LV: Outcome analysis for adults with spondylolisthesis treated with posterolateral fusion and transpedicular screw fixation. J Neurosurg 86:56–63 1997

24.

Scott JHuskisson EC: Graphic representation of pain. Pain 2:1751841976Scott J Huskisson EC: Graphic representation of pain. Pain 2:175–184 1976

25.

Suk SILee CKKim WJLee JHCho KJKim HG: Adding posterior lumbar interbody fusion to pedicle screw fixation and posterolateral fusion after decompression in spondylolytic spondylolisthesis. Spine 22:2102201997Suk SI Lee CK Kim WJ Lee JH Cho KJ Kim HG: Adding posterior lumbar interbody fusion to pedicle screw fixation and posterolateral fusion after decompression in spondylolytic spondylolisthesis. Spine 22:210–220 1997

26.

Thalgott JSSasso RCCotler HBAebi MLaRocca SH: Adult spondylolisthesis treated with posterolateral lumbar fusion and pedicular instrumentation with AO DC plates. J Spinal Disord 3:2042081997Thalgott JS Sasso RC Cotler HB Aebi M LaRocca SH: Adult spondylolisthesis treated with posterolateral lumbar fusion and pedicular instrumentation with AO DC plates. J Spinal Disord 3:204–208 1997

27.

Wenger MMariani LKalbarczyk AGroger U: Long-term outcome of 104 patients after lumbar sequestrectomy according to Williams. Neurosurgery 49:3293352001Wenger M Mariani L Kalbarczyk A Groger U: Long-term outcome of 104 patients after lumbar sequestrectomy according to Williams. Neurosurgery 49:329–335 2001

28.

Zdeblick TA: A prospective, randomized study of lumbar fusion. Preliminary results. Spine 18:9839911993Zdeblick TA: A prospective randomized study of lumbar fusion. Preliminary results. Spine 18:983–991 1993

TrendMD

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 72 72 15
Full Text Views 51 51 8
PDF Downloads 89 89 11
EPUB Downloads 0 0 0

PubMed

Google Scholar