• Justin Swan, Eric Hurwitz, Farbod Malek, Erica van den Haak, Ivan Cheng, Todd Alamin, and Eugene Carragee.
• Department of Orthopaedic Surgery, Spine Surgery Section, Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA 94305-5326, USA.
• Spine J. 2006 Nov 1;6(6):606-14.

Background ContextThe surgical treatment for low-grade isthmic spondylolisthesis in adults with intractable lumbar pain is usually spinal fusion. It has been postulated that anterior column reconstruction may be relatively advantageous in those patients with unstable slips.PurposeTo compare the early and medium term treatment efficacy of two common fusion techniques in isthmic spondylolisthesis.Study Design/SettingProspective controlled trial comparing single-level posterior-lateral instrumented fusion with combined anterior and posterior-lateral instrumented fusion in sequential matched cohorts of patients with radiographically unstable isthmic spondylolisthesis.Outcome MeasuresPrimary outcome measure of success was an Oswestry Disability Index (ODI)MethodsThe study was conducted over a 6-year period. The first cohort of 50 consecutive patients was treated with a single-level instrumented posterior-lateral fusion; the second sequential cohort was treated with an anterior interbody fusion and the same posterior operation. Observations were made at baseline, 6 months, 1 year, and 2 years after surgery. Final radiographic assessment was made at 2 years after surgery.ResultsBaseline demographic and clinical factors were well-matched in the two cohorts. At 2 years, 46 posterior-only fusion subjects and 47 combined fusion subjects completed the full follow-up regimen. Outcomes were better by all measures at 6 months and 12 months in the anterior-posterior cohort. Comparing the primary outcome measure (ODI outcomeConclusionOutcomes up to 2 years were superior by clinically important differences after a combined anterior-posterior operation compared with posterior-alone surgery for unstable spondylolisthesis; however, between-group differences attenuated appreciably after 6 months. The apparent clinical and occupational benefits of combined fusion should be considered along with possible increases in minor complications and procedure-related costs.

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