SURGICAL MANAGEMENT OF SPONDYLOLISTHESIS – A REVIEW OF 68 PATIENTS

Abstract

Surgery for spondylolisthesis is controversial. It is debatable whether a spondylolisthesis should be fused in situ or reduced and fused in the corrected position. In an attempt to address this issue 68 patients who had undergone surgery between 2000 and 2005 for back and leg pain related to a spondylolisthesis with associated spinal stenosis were retrospectively reviewed.

The average age was 53 years. There were 24 male and 44 female patients. A degenerative spondylolisthesis was present in 38 patients while 30 had an isthmic spondylolisthesis. All patients presented with neurogenic back and leg pain that had been present for 6 months. A major neurologic deficit was not present in any patient. The average pre-operative Oswestry score was 42%. Imaging included standard lumbar spine radiographs with dynamic views and MRI. Conservative treatment included pain medication, physiotherapy, nerve root blocks and epidural cortisone injections. A posterior in situ instrumented fusion was performed in 49 patients while 19 underwent reduction and a 360 fusion. A TLIF was used in 11 patients and an ALIF in 8. The average follow-up was 26 months.

Back pain had improved in all patients and the average post-op Oswestry score was 12%. At final follow-up a radiologic fusion was present in all patients. No post-operative neurologic complication was noted in patients who had reduction of the spondylolisthesis. Leg pain persisted in 5 patients (10%) who had posterior in situ fusion while no patient who had a reduction of the spondylolisthesis had residual leg pain. These 5 patients with persistent leg pain underwent removal of the implant and an improvement was noted in 3.

The authors conclude that reduction of the spondylolisthesis with an interbody fusion appears to improve the outcome with regards to neurogenic leg pain. There was no difference in the outcome for back pain.