Long term Outcome after Spinal Fusion for Isthmic Spondylolisthesis in Adults

Publication date: Available online 22 August 2018

Source: The Spine Journal

Author(s): P Endler, P Ekman, H Ljungqvist, TB Brismar, P Gerdhem, H Möller

Abstract

Background context

Data on the long-term outcome after fusion for isthmic spondylolisthesis is scarce.

Purpose

To study patient-reported outcomes and adjacent segment degeneration (ASD) after fusion for isthmic spondylolisthesis and to compare patient-reported outcomes with a control group.

Study design/Setting

Prospective study including a cross-sectional control group.

Patient sample

Patients with isthmic spondylolisthesis underwent posterior lumbar interbody fusion (PLIF) (n=86) or posterolateral fusion (PLF) (n=77). Patient-reported outcome data was available for 73 patients in the PLIF group and 71 in the PLF group at a mean 11 (range 5-16) years after baseline. Seventy-seven patients in the PLIF group and 54 in the PLF group had radiographs at a mean 14 (range 9-19) years after baseline. One hundred thirty-six randomly selected persons from the population served as controls for the patient-reported outcomes.

Outcome measures

Patient-reported outcomes: global outcome, Oswestry Disability Index (ODI), Disability Rating Index (DRI) and Short Form (SF) 36. ASD was determined from radiographs using the UCLA grading scale.

Methods: The Chi-square test or analysis of covariance (ANCOVA) was used for group comparisons. The ANCOVA was adjusted for follow-up time, smoking, Meyerding slippage grade, teetotaler (yes/no) and, when available, the baseline level of the dependent variable. No funds were received for the conduction of this study.  The authors have no conflicts of interest.

Results

There were no significant patient-reported outcome differences between the posterior lumbar interbody fusion group and the posterolateral fusion group. The prevalence of ASD was 42% (32/77) in the posterior lumbar interbody fusion group and 26% (14/54) in the posterolateral fusion group (p=0.98). The patient-reported outcome data indicated lower physical function and more pain in the individuals with surgically treated isthmic spondylolisthesis compared to the controls.

Conclusion

Posterior lumbar interbody fusion and posterolateral fusion had similar long- term patient reported and radiological outcome. Individuals with isthmic spondylolisthesis have lower physical function and more pain several years after surgery when compared to the general population.

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