A critical analysis of the literature regarding surgical approach and outcome for adult low-grade isthmic spondylolisthesis.
Publication/Presentation Date
2-1-2005
Abstract
OBJECTIVE: A systematic review of the radiographic and clinical outcomes of adult patients undergoing surgery for low-grade isthmic spondylolisthesis was performed to determine whether conclusions could be made regarding the optimal choice of surgically managing adult low-grade isthmic spondylolisthesis.
METHODS: We tabulated the radiographic and clinical outcomes of patients who underwent a posterior procedure alone, an anterior procedure alone, or a combined anterior and posterior procedure. We also evaluated the influence of covariates such as laminectomy, spinal internal fixation, smoking, and secondary gain issues on these outcomes. Patients were pooled, and a chi analysis was performed to determine the relationship between surgical approach and patient outcome. A covariate analysis was performed to determine the influence of a laminectomy, spinal fixation, smoking, and secondary gain issues on these outcomes.
RESULTS: The available literature consisted primarily of retrospective case series, with only 4 of 34 reports being prospective randomized controlled studies. Patients with combined anterior and posterior procedures were most likely to achieve a solid fusion and a successful clinical outcome. The use of spinal fixation also increased the chance of fusion and successful clinical outcome.
CONCLUSIONS: A pooling of the surgical literature on adult low-grade spondylolisthesis indicates that a combined anterior and posterior procedure most reliably achieves fusion and a successful clinical outcome. The literature, however, is primarily retrospective and heterogeneous with respect to indications for surgery and methods of evaluating outcome, providing a compelling rationale for a prospective randomized controlled trial of the various surgical approaches to this problem.
Volume
18 Suppl
First Page
30
Last Page
40
ISSN
1536-0652
Published In/Presented At
Kwon, B. K., Hilibrand, A. S., Malloy, K., Savas, P. E., Silva, M. T., Albert, T. J., & Vaccaro, A. R. (2005). A critical analysis of the literature regarding surgical approach and outcome for adult low-grade isthmic spondylolisthesis. Journal of spinal disorders & techniques, 18 Suppl, S30–S40. https://doi.org/10.1097/01.bsd.0000133064.20466.88
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
15699803
Department(s)
Administration and Leadership
Document Type
Article