Transpedicular Fixation for the Treatment of Isthmic Spondylolisthesis in Adults

Abstract

This study analyzed the fusion rate and clinical success rate in adult patients undergoing surgical treatment for symptomatic, low grade, isthmic spondylolisthesis. A postoperative questionnaire and grading scale were used to judge clinical success. Successful fusion was judged using radiographic criteria. To evaluate the clinical success and fusion success in a group of adult patients undergoing instrumented posterolateral arthrodesis for symptomatic isthmic spondylolisthesis. Seventeen consecutive adult patients with symptomatic low grade isthmic spondylolisthesis underwent the identical surgical procedure consisting of Gill laminectomy, L5 nerve root decompression, Luque pedicle-screw plate instrumentation, and posterolateral arthrodesis at L5-S1 using autogenous iliac crest bone graft. Results were analyzed at an average 30-month follow-up. An independent observer reviewed the results using a postoperative questionnaire to determine rates of return to work, symptom relief, and analgesic medication usage. Radiographs were evaluated to determine the fusion status. Seventeen patients were evaluated at an average of 30 months after the index procedure. Sixteen of 17 had solid fusions using radiographic criteria. Sixteen of 17 had satisfactory clinical results. Eight of 13 (62%) employed patients, including three of six patients with worker's compensation, returned to their usual jobs. An instrumented posterolateral arthrodesis in combination with a Gill procedure and L5 nerve root decompression results in a high rate of fusion, satisfactory clinical success, and a high rate of return to work.