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Current Evidence Regarding the Treatment of Pediatric Lumbar Spondylolisthesis: A Report From the Scoliosis Research Society Evidence Based Medicine Committee

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Abstract

Study Design

Structured literature review.

Objectives

The Scoliosis Research Society requested an assessment of the current state of peer-reviewed evidence regarding pediatric lumbar spondylolisthesis to identify what is known and what research remains essential to further understanding.

Summary of Background Data

Pediatric lumbar spondylolisthesis is common, yet no formal synthesis of the published literature regarding treatment has been previously performed.

Methods

A comprehensive literature search was performed. From 6600 initial citations with abstract, 663 articles underwent full-text review. The best available evidence regarding surgical and medical/interventional treatment was provided by 51 studies. None of the studies were graded Level I or II evidence. Eighteen of the studies were Level III, representing the current best available evidence. Thirty-three of the studies were Level IV.

Results

Although studies suggest a benign course for “low grade” (<50% slip) isthmic spondylolisthesis, extensive literature suggests that a substantial number of patients present for treatment with pain and activity limitations. Pain resolution and return to activity is common with both medical/interventional and operative treatment. The role of medical/interventional bracing is not well established. Uninstrumented posterolateral fusion has been reported to produce good clinical results, but concerns regarding nonunion exist. Risk of slip progression is a specific concern in the “high grade” or dysplastic type. Although medical/interventional observation has been reported to be reasonable in a small series of asymptomatic high-grade slip patients, surgical treatment is commonly recommended to prevent progression. There is Level III evidence that instrumentation and reduction lowers the risk of nonunion, and that circumferential fusion is superior to posterior-only or anterior-only fusion. There is Level III evidence that patients with a higher slip angle are more likely to fail medical/interventional treatment of high-grade spondylolisthesis.

Conclusions

The current “best available” evidence to guide the treatment of pediatric spondylolisthesis is presented.

Level of Evidence

Level III; review of Level III studies.

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References

  1. Bartolozzi P, Sandri A, Cassini M, Ricci M. One-stage posterior decompression-stabilization and trans-sacral interbody fusion after partial reduction for severe L5-S1 spondylolisthesis. Spine 2003;28:1135–41.

    PubMed  Google Scholar 

  2. Bourassa-Moreau E, Mac-Thiong JM, Joncas J, et al. Quality of life in patients with high-grade spondylolisthesis: minimum 2-year follow-up after surgical and non-surgical treatments. Spine J 2013;13:770–4.

    Article  PubMed  Google Scholar 

  3. Bouyer B, Bachy M, et al. High-grade lumbosacral spondylolisthesis reduction and fusion in children using transsacral rod fixation. Childs Nerv Syst 2014;30:505–13.

    Article  PubMed  Google Scholar 

  4. Boxall D, Bradford DS, et al. Management of severe spondylolisthesis in children and adolescents. J Bone Joint Surg Am 1979;61:479–95.

    Article  CAS  PubMed  Google Scholar 

  5. Bradford DS. Treatment of severe spondylolisthesis. A combined approach for reduction and stabilization. Spine 1979;4:423–9.

    Article  CAS  PubMed  Google Scholar 

  6. Bradford DS. Closed reduction of spondylolisthesis. An experience in 22 patients. Spine 1988;13:580–7.

    Article  CAS  PubMed  Google Scholar 

  7. Bradford DS, Boachie-Adjei O. Treatment of severe spondylolisthesis by anterior and posterior reduction and stabilization. A long-term follow-up study. J Bone Joint Surg Am 1990;72:1060–6.

    Article  CAS  PubMed  Google Scholar 

  8. Bradford DS, Gotfried Y. Staged salvage reconstruction of grade-IV and V spondylolisthesis. J Bone Joint Surg Am 1987;69:191–202.

    Article  CAS  PubMed  Google Scholar 

  9. Burkus JK, Lonstein JE, et al. Long-term evaluation of adolescents treated operatively for spondylolisthesis. A comparison of in situ arthrodesis only with in situ arthrodesis and reduction followed by immobilization in a cast. J Bone Joint Surg Am 1992;74A:693–704.

    Article  Google Scholar 

  10. DeWald RL, Faut MM, et al. Severe lumbosacral spondylolisthesis in adolescents and children. Reduction and staged circumferential fusion. J Bone Joint Surg Am 1981;63:619–26.

    Article  CAS  PubMed  Google Scholar 

  11. Dubousset J. Treatment of spondylolysis and spondylolisthesis in children and adolescents. Clin Orthop Relat Res 1997;337:77–85.

    Article  Google Scholar 

  12. Fabris DA, Costantini S, et al. Surgical treatment of severe L5-S1 spondylolisthesis in children and adolescents—results of intraoperative reduction, posterior interbody fusion, and segmental pedicle fixation. Spine 1996;21:728–33.

    Article  CAS  PubMed  Google Scholar 

  13. Freeman 3rd BL, Donati NL. Spinal arthrodesis for severe spondylolisthesis in children and adolescents. A long-term follow-up study. J Bone Joint Surg Am 1989;71:594–8.

    Article  PubMed  Google Scholar 

  14. Frennerd AK, Danielson B, Nachemson L. Natural history of symptomatic isthmic low-grade spondylolisthesis in children and adolescents: a seven-year follow-up study. J Pediatr Orthop 1991;11:209–13.

    Article  Google Scholar 

  15. Gaines RW. L5 vertebrectomy for the surgical treatment of spondyloptosis—thirty cases in 25 years. Spine 2005;30:S66–70.

    Article  PubMed  Google Scholar 

  16. Harrington PR, Tullos HS. Spondylolisthesis in children. Observations and surgical treatment. Clin Orthop Relat Res 1971;79:75–84.

    Article  CAS  PubMed  Google Scholar 

  17. Hart RA, Domes CM, et al. High-grade spondylolisthesis treated using a modified Bohlman technique: results among multiple surgeons. J Neurosurg Spine 2014;20:523–30.

    Article  PubMed  Google Scholar 

  18. Helenius I, Lamberg T, et al. Scoliosis research society outcome instrument in evaluation of long-term surgical results in spondylolysis and low-grade isthmic spondylolisthesis in young patients. Spine 2005;30:336–41.

    Article  PubMed  Google Scholar 

  19. Helenius I, Lamberg T, et al. Posterolateral, anterior, or circumferential fusion in situ for high-grade spondylolisthesis in young patients: a long-term evaluation using the Scoliosis Research Society questionnaire. Spine 2006;31:190–6.

    Article  PubMed  Google Scholar 

  20. Helenius I, Remes V, et al. Uninstrumented in situ fusion for highgrade childhood and adolescent isthmic spondylolisthesis: long-term outcome. J Bone Joint Surg Am 2007;89:512–8.

    PubMed  Google Scholar 

  21. Hu SS, Bradford DS, et al. Reduction of high-grade spondylolisthesis using Edwards instrumentation. Spine 1996;21:367–71.

    Article  CAS  PubMed  Google Scholar 

  22. Ishikawa S, Kumar SJ, et al. Surgical treatment of dysplastic spondylolisthesis. Results after in situ fusion. Spine 1994;19:1691–6.

    Article  CAS  PubMed  Google Scholar 

  23. Jalanko T, Helenius I, et al. Operative treatment of isthmic spondylolisthesis in children: a long-term, retrospective comparative study with matched cohorts. Eur Spine J 2011;20:766–75.

    Article  PubMed  Google Scholar 

  24. Johnson JR, Kirwan EO. The long-term results of fusion in situ for severe spondylolisthesis. J Bone Joint Surg Br 1983;65:43–6.

    Article  CAS  PubMed  Google Scholar 

  25. Karampalis C, Grevitt M, et al. High-grade spondylolisthesis: gradual reduction using Magerl’s external fixator followed by circumferential fusion technique and long-term results. Eur Spine J 2012;21(Suppl 2):S200–6.

    Article  PubMed  Google Scholar 

  26. Klein G, Mehlman CT, et al. Nonoperative treatment of spondylolysis and grade I spondylolisthesis in children and young adults: a meta-analysis of observational studies. J Pediat Orthop 2009;29:146–56.

    Article  Google Scholar 

  27. Lamberg TS, Remes VM, et al. Long-term clinical, functional and radiological outcome 21 years after posterior or posterolateral fusion in childhood and adolescence isthmic spondylolisthesis. Eur Spine J 2005;14:639–44.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Lundine KM, Lewis SJ, et al. Patient outcomes in the operative and nonoperative management of high-grade spondylolisthesis in children. J Pediatr Orthop 2014;34:483–9.

    Article  PubMed  Google Scholar 

  29. Mac-Thiong JM, Labelle H. A proposal for a surgical classification of pediatric lumbosacral spondylolisthesis based on current literature. Eur Spine J 2006;15:1425–35.

    Article  PubMed  Google Scholar 

  30. Mehdian SH, Arun R. A new three-stage spinal shortening procedure for reduction of severe adolescent isthmic spondylolisthesis: a case series with medium- to long-term follow-up. Spine 2011;36:E705–11.

    Article  PubMed  Google Scholar 

  31. Molinari RW, Bridwell KH, et al. Anterior column support in surgery for high-grade, isthmic spondylolisthesis. Clin Orthop Relat Res 2002;394:109–20.

    Article  Google Scholar 

  32. Molinari RW, Bridwell KH, et al. Complications in the surgical treatment of pediatric high-grade, isthmic dysplastic spondylolisthesis. A comparison of three surgical approaches. Spine 1999;24:1701–11.

    Article  CAS  PubMed  Google Scholar 

  33. Muschik M, Zippel H, Perka C. Surgical management of severe spondylolisthesis in children and adolescents: anterior fusion in situ vs. anterior spondylodesis with posterior transpedicular instrumentation and reduction. Spine 1997;22:2036–42.

    Article  CAS  PubMed  Google Scholar 

  34. Pizzutillo PD, Hummer 3rd CD. Nonoperative treatment for painful adolescent spondylolysis or spondylolisthesis. J Pediatr Orthop 1989;9:538–40.

    Article  CAS  PubMed  Google Scholar 

  35. Pizzutillo PD, Mirenda W, et al. Posterolateral fusion for spondylolisthesis in adolescence. J Pediatr Orthop 1986;6:311–6.

    Article  CAS  PubMed  Google Scholar 

  36. Poussa M, Remes V, et al. Treatment of severe spondylolisthesis in adolescence with reduction or fusion in situ: long-term clinical, radiologic, and functional outcome. Spine 2006;31:583–90; discussion 591–2.

    Article  PubMed  Google Scholar 

  37. Remes V, Lamberg T, et al. Long-term outcome after posterolateral, anterior, and circumferential fusion for high-grade isthmic spondylolisthesis in children and adolescents: magnetic resonance imaging findings after average of 17-year follow-up. Spine 2006;31:2491–9.

    Article  PubMed  Google Scholar 

  38. Sasso RC, Shively KD, et al. Transvertebral transsacral strut grafting for high-grade isthmic spondylolisthesis L5-S1 with fibular allograft. J Spinal Disord Tech 2008;21:328–33.

    Article  PubMed  Google Scholar 

  39. Scaglietti O, Frontino G, et al. Technique of anatomical reduction of lumbar spondylolisthesis and its surgical stabilization. Clin Orthop Relat Res 1976:165-75.

  40. Schwab FJ, Farcy JP, et al. The sagittal pelvic tilt index as a criterion in the evaluation of spondylolisthesis. Preliminary observations. Spine 1997;22:1661–7.

    Article  CAS  PubMed  Google Scholar 

  41. Schwend RM, Waters PM, et al. Treatment of severe spondylolisthesis in children by reduction and L4-S4 posterior segmental hyperextension fixation. J Pediatr Orthop 1992;12:703–11.

    Article  CAS  PubMed  Google Scholar 

  42. Seitsalo S. Operative and conservative treatment of moderate spondylolisthesis in young patients. J Bone Joint Surg Br 1990;72:908–13.

    Article  CAS  PubMed  Google Scholar 

  43. Seitsalo S, Osterman K, et al. Spondylolisthesis in children under 12 years of age: long-term results of 56 patients treated conservatively or operatively. J Pediatr Orthop 1988;8:516–21.

    Article  CAS  PubMed  Google Scholar 

  44. Sevastikoglou JA, Spangfort E, et al. Operative treatment of spondylolisthesis in children and adolescents with tight hamstrings syndrome. Clin Orthop Relat Res 1980;147:192–9.

    Google Scholar 

  45. Shelokov A, Haider N, et al. Residual gait abnormalities in surgically treated spondylolisthesis. Spine 1993;18:2201–5.

    Article  CAS  PubMed  Google Scholar 

  46. Shufflebarger HL, Geck MJ. High-grade isthmic dysplastic spondylolisthesis: monosegmental surgical treatment. Spine 2005;30:S42–8.

    Article  PubMed  Google Scholar 

  47. Stanton RP, Meehan P, et al. Surgical fusion in childhood spondylolisthesis. J Pediatr Orthop 1985;5:411–5.

    Article  CAS  PubMed  Google Scholar 

  48. Steiner ME, Micheli LJ. Treatment of symptomatic spondylolysis and spondylolisthesis with the modified Boston brace. Spine 1985;10:937–43.

    Article  CAS  PubMed  Google Scholar 

  49. Tiusanen H, Schlenzk D, et al. Results of a trial of anterior or circumferential lumbar fusion in the treatment of severe isthmic spondylolisthesis in young patients. J Pediatr Orthop B 1996;5:190–4.

    Article  CAS  PubMed  Google Scholar 

  50. Transfeldt EE, Mehbod AA. Evidence-based medicine analysis of isthmic spondylolisthesis treatment including reduction versus fusion in situ for high-grade slips. Spine 2007;32(19 Suppl):S126–9.

    Article  PubMed  Google Scholar 

  51. Vanden Berghe L, Maes G, et al. In situ posterolateral fusion for spondylolisthesis. Acta Orthop Belg 1991;57(Suppl 1):214–8.

    Google Scholar 

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Authors and Affiliations

  1. Norton Leatherman Spine Center, 210 E Gray St Suite 900, Louisville, KY, 40202, USA

    Charles H. Crawford III MD

  2. Department of Orthopaedic Surgery, University of Louisville School of Medicine, 550 S. Jackson Street, 1st Floor ACB, Louisville, KY, 40202, USA

    Charles H. Crawford III MD

  3. Department of Orthopedic Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA

    A. Noelle Larson MD

  4. Greater New York Hospital Association, 555 W 57th Street Suite 1500, New York, NY, 10019, USA

    Marilyn Gates MD

  5. Denver International Spine Center, Presbyterian St. Luke’s/Rocky Mountain Hospital for Children, Denver, CO, USA

    R. Shay Bess MD

  6. Gillette Children’s Specialty Healthcare, 200 University Avenue East, St. Paul, MN, 55101, USA

    Tenner J. Guillaume MD

  7. Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th St, New York, NY, 10021, USA

    Han Jo Kim MD

  8. Children’s National Medical Center, 111 Michigan Avenue, NW, Washington, DC, 20010, USA

    Matthew E. Oetgen MD

  9. Department of Orthopaedic Surgery, University of Minnesota, 2512 South 7th St, Suite R200, Minneapolis, MN, 55454, USA

    Charles G. Ledonio MD

  10. Department of Orthopaedics and Rehabilitation, University of Rochester, 601 Elmwod Avenue, Box 665, Rochester, NY, 14642, USA

    James Sanders MD

  11. Marc A Asher MD Comprehensive Spine Center, 3901 Rainbow Blvd, MS 3017, Kansas City, KS, 66160, USA

    Douglas C. Burton MD

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  1. Charles H. Crawford III MD
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  2. A. Noelle Larson MD
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Correspondence to Charles H. Crawford III MD.

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Crawford, C.H., Larson, A.N., Gates, M. et al. Current Evidence Regarding the Treatment of Pediatric Lumbar Spondylolisthesis: A Report From the Scoliosis Research Society Evidence Based Medicine Committee. Spine Deform 5, 284–302 (2017). https://doi.org/10.1016/j.jspd.2017.03.011

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  • DOI: https://doi.org/10.1016/j.jspd.2017.03.011

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