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40% reoperation rate in adolescents with spondylolisthesis

  • Case Series
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Abstract

Study design

Multicenter retrospective.

Objective

To determine the long-term complication rate associated with surgical treatment of spondylolisthesis in adolescents.

Summary of background data

There is limited information on the complication rate associated with posterior spinal fusion (PSF) of spondylolisthesis in the pediatric and adolescent population.

Methods

Patients who underwent PSF for spondylolisthesis between 2004 and 2015 at four spine centers, < 21 years of age, were included. Exclusion criteria were < 2 years of follow-up or anterior approach. Charts and radiographs were reviewed.

Results

50 patients had PSF for spondylolisthesis, 26 had PSF alone, while 24 had PSF with trans-foraminal lumbar interbody fusion (TLIF). Mean age was 13.9 years (range 9.6–18.4). Mean follow-up was 5.5 years (range 2–15). Mean preoperative slip was 61.2%. 20/50 patients (40%) experienced 23 complications requiring reoperation at a mean of 2.1 years (range 0–9.3) for the following: implant failure (12), persistent radiculopathy (3), infection (3), persistent back pain (2), extension of fusion (2), and hematoma (1). In addition, there were 22 cases of radiculopathy (44%) that were transient. Rate of implant failure was related to preoperative slip angle (p = 0.02). Reoperation rate and rates of implant failure were not associated with preoperative % slip (reoperation: p = 0.42, implant failure: p = 0.15), postoperative % slip (reoperation: p = 0.42, implant failure: p = 0.99), postoperative kyphosis of the lumbosacral angle (reoperation: p = 0.81, implant failure: p = 0.48), change in % slip (reoperation: p = 0.30, implant failure: p = 0.12), change in slip angle (reoperation: p = 0.42, implant failure: p = 0.40), graft used (reoperation: p = 0.22, implant failure: p = 0.81), or addition of a TLIF (reoperation: p = 0.55, implant failure: p = 0.76).

Conclusion

PSF of spondylolisthesis in the adolescent population was associated with a 40% reoperation rate and high rate of post-operative radiculopathy. Addition of a TLIF did not impact reoperation rate or rate of radiculopathy.

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Fig. 1

Reproduced with Permission from the Children’s Orthopaedic Center, Los Angeles

Fig. 2

Reproduced with Permission from the Children’s Orthopaedic Center, Los Angeles

Fig. 3

Reproduced with Permission from the Children’s Orthopaedic Center, Los Angeles

Fig. 4

Reproduced with Permission from the Children’s Orthopaedic Center, Los Angeles

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Funding

This study has been carried out with approval from the Institutional Review Board at Children’s Hospital Los Angeles. None of the authors received financial support for this study.

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Authors and Affiliations

  1. Children’s Orthopaedic Center, Children’s Hospital Los Angeles, 4650 Sunset Blvd, Mailstop #69, Los Angeles, CA, 90027, USA

    Ena Nielsen, Lindsay M. Andras, Ali A. Siddiqui & David L. Skaggs

  2. Orthopedics Institute, Children’s Hospital Colorado, Aurora, USA

    Nicole Michael & Sumeet Garg

  3. OrthoCarolina-Pediatric Orthopedic Center, Charlotte, USA

    Michael Paloski

  4. Department of Orthopaedic Surgery, Carolinas Healthcare System, Levine Children’s Hospital, Charlotte, USA

    Brian K. Brighton

  5. Department of Pediatric Orthopaedics, Robert-Debré Hospital, Paris, France

    Emmanuelle Ferrero, Keyvan Mazda & Brice Ilharreborde

Authors
  1. Ena Nielsen
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  2. Lindsay M. Andras
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  3. Ali A. Siddiqui
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  4. Nicole Michael
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  5. Sumeet Garg
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  6. Michael Paloski
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  7. Brian K. Brighton
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  8. Emmanuelle Ferrero
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  9. Keyvan Mazda
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  10. Brice Ilharreborde
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  11. David L. Skaggs
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Contributions

EN data collection, data analysis, manuscript preparation, final approval of manuscript. LMA study design, manuscript preparation, manuscript review, final approval of manuscript. AS data collection, manuscript preparation, final approval of manuscript. NM data collection, manuscript review, final approval of manuscript. SG study design, manuscript review, final approval of manuscript. MP study design, manuscript review, final approval of manuscript. BKB study design, manuscript review, final approval of manuscript. EF study design, manuscript review, final approval of manuscript. KM study design, manuscript review, final approval of manuscript. BI study design, manuscript review, final approval of manuscript. DLS study design, manuscript review, final approval of manuscript.

Corresponding author

Correspondence to David L. Skaggs.

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Nielsen, E., Andras, L.M., Siddiqui, A.A. et al. 40% reoperation rate in adolescents with spondylolisthesis. Spine Deform 8, 1059–1067 (2020). https://doi.org/10.1007/s43390-020-00121-5

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  • DOI: https://doi.org/10.1007/s43390-020-00121-5

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