Long-term results of the direct repair of spondylolisthesis.

Direct repair of spondylolisthesis can save a functional segment in young patients with slight slipping. Since 1968 many surgeons have proposed different technical solutions to obtain the isthmic repair. Their results changed according to the technique used, the extent of listhesis and the age of the patient. The aim of our study was to perform a retrospective review on the long-term results of the direct repair of spondylolisthesis, according to the different techniques used. We operated 62 patients for isthmic repair, with three different techniques, from 1994 to 2007. We analysed the clinical and radiographic results of 52 cases, with an average follow-up of 9 ± 3 years (range 2-15). Ten patients were lost to the follow-up. The results were different depending on the technique used. Good or excellent clinical outcome by Odom's criteria were observed in the 83.3% of patients operated with the modified Scott technique. These results are better than those obtained in the group of patients operated with the Scott (62.5%) and the Buck technique (28.5%). Patients with clinical and radiological failure, who then underwent spinal fusion, were 57% with the Buck technique, 12.5% with the Scott technique and 2.7% with the Scott modified technique. The reasons for a new operation were symptomatic pseudarthrosis and progression of slipping. In conclusion, the pars defect repair is a helpful technique in lumbar spondylolisthesis, especially in young patient with slight slipping and painful symptoms resistant to conservative treatment. In our experience, the modified Scott technique seems to provide a better outcome than the Scott and Buck techniques.