Treatment Of Low-grade Spondylolisthesis Research Articles

Predictors of Delayed Clinical Benefit Following Surgical Treatment for Low Grade Spondylolisthesis.

Retrospective review of prospectively collected data. To investigate what factors predict delayed improvement after surgical treatment of low grade spondylolisthesis. Lumbar surgery leads to clinical improvement in the majority of patients with low grade spondylolisthesis. Most patients improve rapidly after surgery, but some patients demonstrate a delayed clinical course. The Quality and Outcomes Database (QOD) was queried for grade 1 spondylolisthesis patients who underwent surgery who had patient reported outcome measures (PROMs) collected at baseline, 3-, 6- and 12-months, including back and leg pain numeric rating scale (NRS), Oswestry Disability Index (ODI), and EuroQol-5D (EQ-5D). Patients were stratified as "Early responders" reaching MCID at 3 months and maintaining improvement through 12 months and "Delayed responders" not reaching MCID at 3 months but ultimately reaching MCID at 12 months. These two groups were compared with respect to factors which predicted delayed improvement. Of 608 patients enrolled, 436 (72%) met inclusion criteria for this study. Overall, 317 patients (72.7%) reached MCID for ODI at 12 months following surgery. Of these patients, 249 (78.5%) exhibited a rapid clinical improvement trajectory and had achieved ODI MCID threshold by the 3-month postop follow-up. 68 patients (21.4%) showed a delayed trajectory, and had not achieved ODI MCID threshold at 3 months, but did ultimately reach MCID at 12-month follow-up. Factors associated with delayed improvement included impaired preoperative ambulatory status, better baseline back and leg pain scores, and worse 3-month leg pain scores (P<0.01). The majority of patients undergoing surgery for low grade spondylolisthesis reach ODI MCID threshold rapidly, within the first three months after surgery. Factors associated with a delayed clinical course include impaired preoperative ambulation status, relatively better preoperative back and leg pain, and persistent leg pain at 3 months.

Surgical treatment of low grade spondylolisthesis: the modern state of the problem

The paper presents a literature review on contemporary problems of surgical treatment of low grade spondylolisthesis. The results of various surgical techniques including modern minimally invasive methods of treatment are provided. The importance of selecting a method of surgical intervention depending on the type of spondylolisthesis, sacro-pelvic balance, and global sagittal balance is indicated, as well as their influence on the quality of life of patients. Complications and causes of pseudoarthrosis development depending on different methods of interbody fusion are discussed. The choice of optimal treatment tactic is the main problem in surgery of low grade spondylolisthesis.

Posterior Lumbar Interbody Fusion (PLIF) augmented with Pedicle Screw Fixation Versus PLIF augmented with Percutaneous Pedicle Screw Fixation in Low Grade Lumbar Spondylolisthesis

Background Data: The optimal treatment for patients with Spondylolisthesis has been the subject of many recent studies which provide some of the best evidence for lumbar spinal fusion. Purpose: Compare the clinical and radiological outcome of treating low grade lumbar spondylolisthesis patients with PLIF augmented with PSF versus those treated with PLIF augmented with Percutaneous PSF. Study Design: This is a prospective comparative clinical case study.Patients and Methods: Seventeen patients with low grade spondylolisthesis who underwent instrumented fixation were retrospectively analyzed from the period of 2011 to 2012. A PLIF and PSF (Group A) was performed in 9 patients, andPLIF and percutaneous PSF (Group B) was performed in 8 patients. Data were collected preoperatively and at 6 months after surgery. A comparative analysis was made between the 2 groups using visual analog pain scale (VAS) before andafter surgery, and functional disability was assessed using the Oswestry Disability Index (ODI), by which low back pain, disability were assisted using a questionnaire and radiological (dynamic plain radiographs and CT scans) measures.Results: Follow-up duration was 6 months. The mean preoperative scores on the VAS for low-back pain in Groups A and B were 55 and 54, respectively, decreasing to 43 and 39, respectively, at 6 months after surgery (P=0.003). Themean preoperative scores on the VAS for leg pain in Groups A and B were 65 and 61, respectively, decreasing at 6 months after surgery to 43 and 40, respectively (P=0.031), The fusion rates in Groups A and B were obtained in all 17 cases withvariable rates of fusion in groups A 88.9% and in group B 75% at 6 months after surgery (P=0.008), There was no significant difference in terms of the complication rate between Group A (4.5%) and B (3.9%) (P=0.781).Conclusion: Patients with PLIF and PSF results were much better than those with PLIF and percutaneous PSF. The postoperative back pain was much less in the percutaneous group and relatively longer time for fusion. These results seem to favor PLIF with SF rather than PLIF with percutaneous PSF in the treatment of low grade spondylolisthesis. (2013ESJ042)

Outcomes of strengthening approaches in the treatment of low-grade spondylolisthesis

Background: Historically, spondylolisthesis has been treated by a wide variety of techniques such as flexion exercises, bracing, abdominal stabilizing programs, general strengthening, stretching, and in some cases, motor control exercises. Although surgical treatment of spondylolisthesis has been outlined in current literature, strengthening programs have not been well defined for this population.Objective: To describe the outcomes in randomized clinical or controlled trials (RCTs) in which either a global or local strengthening approach was assessed against another comparator in conservative treatment of patients with a low-grade spondylolisthesis.Methods: A systematic review of the literature. This review was formatted using the PRISMA guidelines, a 27-item checklist and four-phase flow diagram. An electronic search strategy targeting randomized controlled and clinical trials that compared conservative treatments for low-grade (I and II) spondylolisthesis that used a local stabilization approach, motor control, and/or a general strengthening program versus a surgical intervention or a control group was used. Physiotherapy Evidence Database (PEDro) was used to critically appraise each study for quality. Outcome measures included changes in pain measured by the visual analog scale (VAS) along with secondary measures of functional disability, working status, and lumbar range of motion.Results: Although 28 studies went through full text review, only three studies met inclusion criteria. Within the studies, global strengthening exercise programs significantly decreased subjects’ pain as measured using the VAS but did not significantly improve the level of disability. In contrast, local stabilization or motor control exercises demonstrated improvements in both pain and disability. No studies directly compared a global strengthening approach versus a stabilization approach.Conclusion: Our findings indicate that both exercise training programs of local strengthening/stabilization interventions, as well as general strengthening programs may be beneficial as conservative strengthening management to patients with a low-grade spondylolisthesis. A direct comparison of these approaches is needed for the spondylolisthesis population.

Radiological and clinical outcomes of posterolateral fusion versus posterior lumbar interbody fusion for spondylolisthesis

Objective To compare two different kinds of operation: instrumented posterolateral lumbar fusion (PLF) and instrumented posterior lumbar interbody fusion (PLIF) in the treatment of low grade spondylolisthesis. Methods We retrospectively analyzed patients who received these two kinds of operation for low grade spondylolisthesis between June 2004 and December 2006, including PLF in 53 and PLIF in 60. Disc height, Boxall index, segment angle and area of intervertebral foramen were compared both before and after the operation and during the follow-ups as radiological measurement. The Oswestry disability index(OPI) and visual analogue scale (VAS) were measured to compare low back pain, leg pain, and disability. Anatomical reduction rate and fusion rate were also calculated. The radiological measurements and the clinical indexes were compared at the last follow-up. Results The average operation time and blood loss was: PLIF, (194.3±54.7) min, (402.2±123.9) ml; PLF, (179.3±45.7) min, (367.2±102.3) mi, which were of no statistical significance. PLIF group turned up better results in all the post operation radiological measurements, which was statistically significant. The fusion rate was 96.7% and 86.8% respectively, which was not statistically different. The VAS for both lumbar and leg pain as well as the ODI were improved either post operation or in the one year follow-up. The excellent rate for subjective evaluation was 56.7% in PLIF group and 37.7% in PLF group. Conclusion Instrumented PLIF is an effective treatment for low grade spondylolisthesis. It has yield superiority over PLF in correction of spondylolisthesis, maintenance of disc height, regaining of lumbar lordosis and enlargement of intervertebral foramen area, and contributes to a higher rate of excellent results. Key words: Spondylolisthesis; Lumbar vertebrae; Spinal fusion

Long-term disability assessment after surgical treatment of low grade spondylolisthesis.

The aim of this study was to determine whether assessment of back surgery with disability scores is relevant. We also attempted to answer the question of whether this evaluation should be conducted by a surgeon or a medical doctor. This retrospective study analyzes the long-term outcome (average follow-up 7 years, range: 3-12) of 40 patients (mean age: 46.2 years) treated by posterior surgical decompression, posterolateral arthrodesis, with or without instrumentation, for symptomatic low-grade spondylolisthesis. All patients were interviewed postoperatively and examined the same day by an orthopedic surgeon, who was not involved in the patients' treatment, as well as by a medical doctor rehabilitation specialist. Impairment was assessed by a standardized clinical examination and by visual analog scales (VAS) of pain. Disability was assessed using two scales: the Quebec disability scale and the Beaujon scale. Anxiety and depression were assessed with a validated specific questionnaire (HAD). Patient's perceived handicap was assessed on a 100-mm VAS. Our results show that the scores of the two disability scales were highly correlated with the patient's overall satisfaction ( r = 0.73 and 0.77 for the Quebec scale and the Beaujon scale, respectively). The intraclass correlation coefficient showed very good or excellent correlation between the data collected by the surgeon and the rehabilitation specialist, ranging from 0.8 to 0.97. This finding clearly demonstrates that interview by a surgeon who is not involved in the patient's treatment does not influence the patient's assessment in terms of impairment, disability, or handicap. Moreover, our results suggest that disability scales are the most relevant outcome measures in the assessment of spine surgery.