Abstract
Objective: To determine if there was any difference in standard spine outcome measures for single level degenerative lumbar spondylolisthesis treated by decompression and intertransverse fusion alone or with pedicle screw instrumentation.
Methods: A prospective longitudinal cohort study was undertaken looking at 23 patients undergoing surgery for L4/5 degenerative spondylolisthesis with symptomatic spinal stenosis. Clinical outcome was assessed through specific outcome measures of walking distance(yards), Oswestry disability index (ODI), Back Functional Assessment (BFA) and Visual analogue score for pain(VAS).
Results: Follow up was achieved in 21 patients (91%) and the mean length of follow up was 29 months (range 12–60 months). The mean age at operation was 66 years. In the uninstrumented group (n=12), the mean pre and post operative outcome scores were: walking distance (pre-122, post-950), ODI (pre-45, post-29), BFA (pre-23, post-31) and VAS (pre-83, post 49). In the instrumented group (n=11), the mean pre- and post operative outcome scores were: walking distance (pre-143, post-763), ODI (pre-54, post-33), BFA (pre-14, post 33) and VAS (pre-77, post-49). There was no statistically significant difference in improvement in each outcome measure between the two groups.
Conclusion: Surgical decompression in degenerative spondylolisthesis aims to relieve symptoms of radicular pain and neurogenic claudication. However, the indications for instrumentation are controversial. Previous studies have shown an improved fusion rate with instrumentation but no difference in subjective patient satisfaction scores. We have used validated patient based outcome measures to assess clinical outcome. Our results show no statistically significant difference between single level L4/5 degenerative spondylolisthesis treated with decompression with or without instrumentation.
Correspondence should be addressed to: Mr N. J. Henderson, BASS, c/o BOA, The Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE.
