OBJECTIVE: A systematic review of the radiographic and clinical outcomes of adult patients undergoing surgery for low-grade isthmic spondylolisthesis was performed to determine whether conclusions could be made regarding the optimal choice of surgically managing adult low-grade isthmic spondylolisthesis. METHODS: We tabulated the radiographic and clinical outcomes of patients who underwent a posterior procedure alone, an anterior procedure alone, or a combined anterior and posterior procedure. We also evaluated the influence of covariates such as laminectomy, spinal internal fixation, smoking, and secondary gain issues on these outcomes. Patients were pooled, and a chi analysis was performed to determine the relationship between surgical approach and patient outcome. A covariate analysis was performed to determine the influence of a laminectomy, spinal fixation, smoking, and secondary gain issues on these outcomes. RESULTS: The available literature consisted primarily of retrospective case series, with only 4 of 34 reports being prospective randomized controlled studies. Patients with combined anterior and posterior procedures were most likely to achieve a solid fusion and a successful clinical outcome. The use of spinal fixation also increased the chance of fusion and successful clinical outcome. CONCLUSIONS: A pooling of the surgical literature on adult low-grade spondylolisthesis indicates that a combined anterior and posterior procedure most reliably achieves fusion and a successful clinical outcome. The literature, however, is primarily retrospective and heterogeneous with respect to indications for surgery and methods of evaluating outcome, providing a compelling rationale for a prospective randomized controlled trial of the various surgical approaches to this problem.
OBJECTIVE: A systematic review of the radiographic and clinical outcomes of adult patients undergoing surgery for low-grade isthmic spondylolisthesis was performed to determine whether conclusions could be made regarding the optimal choice of surgically managing adult low-grade isthmic spondylolisthesis. METHODS: We tabulated the radiographic and clinical outcomes of patients who underwent a posterior procedure alone, an anterior procedure alone, or a combined anterior and posterior procedure. We also evaluated the influence of covariates such as laminectomy, spinal internal fixation, smoking, and secondary gain issues on these outcomes. Patients were pooled, and a chi analysis was performed to determine the relationship between surgical approach and patient outcome. A covariate analysis was performed to determine the influence of a laminectomy, spinal fixation, smoking, and secondary gain issues on these outcomes. RESULTS: The available literature consisted primarily of retrospective case series, with only 4 of 34 reports being prospective randomized controlled studies. Patients with combined anterior and posterior procedures were most likely to achieve a solid fusion and a successful clinical outcome. The use of spinal fixation also increased the chance of fusion and successful clinical outcome. CONCLUSIONS: A pooling of the surgical literature on adult low-grade spondylolisthesis indicates that a combined anterior and posterior procedure most reliably achieves fusion and a successful clinical outcome. The literature, however, is primarily retrospective and heterogeneous with respect to indications for surgery and methods of evaluating outcome, providing a compelling rationale for a prospective randomized controlled trial of the various surgical approaches to this problem.
Authors: Mohammed Farooq Butt; Shabir Ahmed Dhar; Imtiyaz Hakeem; Munir Farooq; Manzoor Ahmed Halwai; Mohammad Ramzan Mir; Khursheed Ahmed Kangu Journal: Int Orthop Date: 2007-05-11 Impact factor: 3.075
Authors: Christopher K Kepler; Russel C Huang; Amit K Sharma; Dennis S Meredith; Ochuko Metitiri; Andrew A Sama; Federico P Girardi; Frank P Cammisa Journal: Orthop Surg Date: 2012-05 Impact factor: 2.071
Authors: Martin H Pham; Ian A Buchanan; Courtney S Lewis; Vance Fredrickson; Alexandra Kammen; Joshua Bakhsheshian; Frank L Acosta Journal: Int J Spine Surg Date: 2019-10-31