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In situ instrumented posterolateral fusion without decompression in symptomatic low-grade isthmic spondylolisthesis in adults

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Abstract

Forty patients with an average age of 26.5 years were treated for symptomatic low-grade isthmic spondylolisthesis with in situ instrumented posterolateral fusion. All patients had failed previous conservative treatment. Average follow-up was 42.2 months (range: 30–62 months). Low-back pain resolved in 70% of the patients, whereas 65% of those with radicular pain reported complete resolution of the symptoms. At the final follow-up 82.5% of the patients had improvement in their function. Solid fusion was achieved in 70% of the patients. It was uncertain in 10% and a fusion failure was seen in 20%. The anterior slippage as measured by the Taillard method was 31.55% and an average 35% correction was seen after surgery. However, an average 10% loss of correction was seen at the final evaluation. The clinical results were evaluated by Kim and Kim criteria. Satisfactory results were obtained in 65% of patients and this was closely associated with the rate of successful fusion. The results suggest that clinical outcome is closely related to the attainment of solid fusion and decompression or removal of the loose laminar fragment seems unnecessary in patients without major neurological symptoms.

Résumé

Quarante patients dont la moyenne d’âge était de 26.5 ans ont été traités pour un spondylolisthesis symptomatique de bas grade avec une arthrodèse postérolatérale instrumentatée en place. Tous les patients avaient eu avant l’intervention un traitement orthopédique conservateur qui avait échoué. Le suivi moyen était de 42.2 mois (entre 30 à 62 mois). Le problème des lombalgies a été résolu chez 70% des patients, 65% d’entre eux présentant des douleurs radiculaires ont vue celles-ci disparaître. Au suivi final, 82.5% des patients ont été améliorés sur le plan fonctionnel. Une greffe solide a été obtenue chez 70% des patients. Un échec de la greffe a été constatée chez 20% des patients et dans 10% d’entre eux il a été difficile d’affirmer la solidité. Le glissement antérieur a été mesuré selon la technique de Taillard, il était de 31.55% avec une moyenne de correction de 35% après l’intervention. Cependant, il faut constater une perte de correction de 10% à l’évaluation finale. Le résultat clinique a été évalué selon les critères de Kim et Kim, avec des résultats satisfaisants chez les 2/3 des patients, ces bons résultats étant toujours associés à une bonne greffe. Ceci nous incite à penser que ce traitement sans décompression et sans ablation de l’arc postérieur peut entraîner un bon résultat et que ces gestes ne sont pas indispensables chez ces patients.

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Correspondence to Mohammed Farooq Butt.

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Butt, M.F., Dhar, S.A., Hakeem, I. et al. In situ instrumented posterolateral fusion without decompression in symptomatic low-grade isthmic spondylolisthesis in adults. International Orthopaedics (SICO 32, 663–669 (2008). https://doi.org/10.1007/s00264-007-0367-0

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  • DOI: https://doi.org/10.1007/s00264-007-0367-0

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