The Journal of Bone and Joint Surgery, Vol 74, Issue 5 693-704, Copyright © 1992 by Journal of Bone and Joint Surgery, Inc
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
JK Burkus, JE Lonstein, RB Winter and F Denis
Minnesota Spine Center, Minneapolis 55454-1419.
The medical records and radiographs of forty-two adolescents (twenty-three
male and nineteen female) who had had a posterolateral spinal arthrodesis
for spondylolisthesis between 1950 and 1986 were reviewed to assess the
long-term outcome of this form of treatment. The average age of the
patients at the time of the operation was fourteen years (range, seven
years and nine months to seventeen years and eleven months). The duration
of the clinical and radiographic follow-up ranged from two years to
twenty-seven years and seven months. All patients had an in situ
arthrodesis of the involved vertebrae. Eighteen patients had no additional
intervention, and twenty-four patients had reduction and application of a
cast. Use of the cast led to a decrease in sagittal translation of more
than 5 per cent in eighteen patients and a decrease in lumbosacral kyphosis
(the slip angle) of more than 5 degrees in fourteen patients. Of the
patients who did not have a cast, eight had an increase in sagittal
translation of more than 5 per cent and ten had an increase in lumbosacral
kyphosis of more than 5 degrees. There were no neurological problems at the
time of the initial operation or after the reduction maneuver. At the most
recent clinical follow-up examination, thirty-eight patients had no
complaints of low-back pain or any restriction of work-related or
recreational activities. Persistent low-back pain and pain in the lower
extremities limited the activities of the remaining four patients, two of
whom had another operation to alleviate these symptoms.
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