• Spine · Jan 2006

    Comparative Study

    Posterolateral, anterior, or circumferential fusion in situ for high-grade spondylolisthesis in young patients: a long-term evaluation using the Scoliosis Research Society questionnaire.

    • Ilkka Helenius, Tommi Lamberg, Kalevi Osterman, Dietrich Schlenzka, Timo Yrjönen, Pekka Tervahartiala, Seppo Seitsalo, Mikko Poussa, and Ville Remes.
    • ORTON Orthopaedic Hospital, Invalid Foundation, Finland. ilkka.helenius@helsinki.fi
    • Spine. 2006 Jan 15; 31 (2): 190-6.

    Study DesignA retrospective, comparative follow-up study.ObjectiveTo compare clinical and radiographic outcomes after posterolateral, anterior, or circumferential fusion in situ for high-grade spondylolisthesis in children and adolescents.Summary Of Background DataControversial opinions still exist about the surgical treatment of severe isthmic spondylolisthesis. There are no long-term comparative studies of different fusion in situ techniques in these patients.MethodsA total of 21 patients treated using posterolateral, 23 using anterior, and 26 using the circumferential fusion technique without instrumentation for high-grade isthmic spondylolisthesis (>or=50% slip) participated. Their mean age at surgery was 14.4 years (range 8.0-19.6). The follow-up rate was 84% after a mean of 17.2 years (range 10.7-26.0). Radiographs were obtained before surgery, at 2-year follow-up, and at final follow-up. The Scoliosis Research Society (SRS) and Oswestry Disability Index questionnaires were completed, and a physical examination was performed at the final follow-up visit.ResultsProgression of lumbosacral kyphosis (>or=10 degrees ) was found in 9 (43%), 3 (13%), and 3 (12%) patients of the posterolateral, anterior, and circumferential fusion groups, respectively (P = 0.017). The SRS total score averaged 89.7 (range 56-105) in the posterolateral, 93.2 (range 66-114) in the anterior, and 100.0 (range 71-117) in the circumferential fusion groups (P = 0.021). Patients in the circumferential fusion group had better values for pain (P = 0.023) and function from back condition domains (P = 0.079) than patients in the posterolateral or anterior groups. The Oswestry Disability Index averaged 9.7 (range 0-62) in the posterolateral, 8.9 (range 0-32) in the anterior, and 3.0 (range 0-16) in the circumferential fusion groups (P = 0.035).ConclusionsCircumferential fusion provided significantly better long-term clinical, radiographic, and SRS total score than posterolateral or anterior fusion for high-grade isthmic spondylolisthesis.

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