Clin Orthop Surg.  2014 Jun;6(2):185-189. 10.4055/cios.2014.6.2.185.

Comparison of Functional Outcomes following Surgical Decompression and Posterolateral Instrumented Fusion in Single Level Low Grade Lumbar Degenerative versus Isthmic Spondylolisthesis

• Omidi-Kashani F
• Hasankhani EG
• Rahimi MD
• Khanzadeh

• KMID: 1784665
• DOI: http://doi.org/10.4055/cios.2014.6.2.185

Abstract

BACKGROUND
The two most common types of surgically treated lumbar spondylolisthesis in adults include the degenerative and isthmic types. The aim of this study was to compare the functional outcomes of surgical decompression and posterolateral instrumented fusion in patients with lumbar degenerative and isthmic spondylolisthesis.
METHODS
In this retrospective study, we reviewed the clinical outcomes in surgically treated patients with single level, low grade lumbar degenerative, and isthmic spondylolisthesis (groups A and B, respectively) from August 2007 to April 2011. We tried to compare paired settings with similar initial conditions. Group A included 52 patients with a mean age of 49.2 +/- 6.1 years, and group B included 52 patients with a mean age of 47.3 +/- 7.4 years. Minimum follow-up was 24 months. The surgical procedure comprised neural decompression and posterolateral instrumented fusion. Pain and disability were assessed by a visual analog scale (VAS) and the Oswestry Disability Index (ODI), respectively. The Wilcoxon and Mann-Whitney U-tests were used to compare indices.
RESULTS
The most common sites for degenerative and isthmic spondylolisthesis were at the L4-L5 (88.5%) and L5-S1 (84.6%) levels, respectively. Surgery in both groups significantly improved VAS and ODI scores. The efficacy of surgery based on subjective satisfaction rate and pain and disability improvement was similar in the degenerative and isthmic groups. Notable complications were also comparable in both groups.
CONCLUSIONS
Neural decompression and posterolateral instrumented fusion significantly improved pain and disability in patients with degenerative and isthmic spondylolisthesis. The efficacy of surgery for overall subjective satisfaction rate and pain and disability improvement was similar in both groups.

Keyword

Degenerative spondylolisthesis; Isthmic spondylolisthesis; Lumbar spine; Instrumentation; Fusion

MeSH Terms

Adult
Aged
Decompression, Surgical
Female
Humans
Lumbar Vertebrae/surgery
Male
Middle Aged
Recovery of Function
Spinal Fusion
Spondylolisthesis/diagnosis/*surgery
Treatment Outcome

Reference

1. Iguchi T, Wakami T, Kurihara A, Kasahara K, Yoshiya S, Nishida K. Lumbar multilevel degenerative spondylolisthesis: radiological evaluation and factors related to anterolisthesis and retrolisthesis. J Spinal Disord Tech. 2002; 15(2):93–99.

2. Wild A, Seller K, Krauspe R. Surgical therapy for spondylolysis and spondylolisthesis. Orthopade. 2005; 34(10):995–1006.

3. Haun DW, Kettner NW. Spondylolysis and spondylolisthesis: a narrative review of etiology, diagnosis, and conservative management. J Chiropr Med. 2005; 4(4):206–217.

4. Tsahtsarlis A, Wood M. Minimally invasive transforaminal lumbar interbody fusion and spondylolisthesis. J Clin Neurosci. 2012; 19(6):858–861.

5. Wang J, Zhou Y, Zhang ZF, et al. Clinical study on lumbar spondylolisthesis treated by minimally invasive transforaminal lumbar interbody fusion. Zhonghua Wai Ke Za Zhi. 2011; 49(12):1076–1080.

6. Wang J, Zhou Y, Zhang ZF, Li CQ, Zheng WJ, Liu J. Comparison of one-level minimally invasive and open transforaminal lumbar interbody fusion in degenerative and isthmic spondylolisthesis grades 1 and 2. Eur Spine J. 2010; 19(10):1780–1784.

7. Kim JS, Kim DH, Lee SH. Comparison between instrumented mini-TLIF and instrumented circumferential fusion in adult low-grade lytic spondylolisthesis: can mini-TLIF with PPF replace circumferential fusion? J Korean Neurosurg Soc. 2009; 45(2):74–80.

8. Park Y, Ha JW, Lee YT, Oh HC, Yoo JH, Kim HB. Surgical outcomes of minimally invasive transforaminal lumbar interbody fusion for the treatment of spondylolisthesis and degenerative segmental instability. Asian Spine J. 2011; 5(4):228–236.

9. Lauber S, Schulte TL, Liljenqvist U, Halm H, Hackenberg L. Clinical and radiologic 2-4-year results of transforaminal lumbar interbody fusion in degenerative and isthmic spondylolisthesis grades 1 and 2. Spine (Phila Pa 1976). 2006; 31(15):1693–1698.

10. Gehrchen PM, Dahl B, Katonis P, Blyme P, Tondevold E, Kiaer T. No difference in clinical outcome after posterolateral lumbar fusion between patients with isthmic spondylolisthesis and those with degenerative disc disease using pedicle screw instrumentation: a comparative study of 112 patients with 4 years of follow-up. Eur Spine J. 2002; 11(5):423–427.

11. O'Sullivan PB. Lumbar segmental 'instability': clinical presentation and specific stabilizing exercise management. Man Ther. 2000; 5(1):2–12.

12. Denard PJ, Holton KF, Miller J, et al. Back pain, neurogenic symptoms, and physical function in relation to spondylolisthesis among elderly men. Spine J. 2010; 10(10):865–873.

13. Sigmundsson FG, Kang XP, Jonsson B, Stromqvist B. Prognostic factors in lumbar spinal stenosis surgery. Acta Orthop. 2012; 83(5):536–542.

14. Wewers ME, Lowe NK. A critical review of visual analogue scales in the measurement of clinical phenomena. Res Nurs Health. 1990; 13(4):227–236.

15. Fairbank JC, Pynsent PB. The Oswestry Disability Index. Spine (Phila Pa 1976). 2000; 25(22):2940–2952.

16. Mousavi SJ, Parnianpour M, Mehdian H, Montazeri A, Mobini B. The Oswestry Disability Index, the Roland-Morris Disability Questionnaire, and the Quebec Back Pain Disability Scale: translation and validation studies of the Iranian versions. Spine (Phila Pa 1976). 2006; 31(14):E454–E459.

17. Wood EG III, Hanley EN Jr. Lumbar disc herniation and open limited discectomy: indications, techniques, and results. Oper Tech Orthop. 1991; 1(1):23–28.

18. Moon MS, Kim SS, Sun DH, Moon YW. Anterior spondylodesis for spondylolisthesis: isthmic and degenerative types. Eur Spine J. 1994; 3(3):172–176.