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Decompression without Fusion for Low-Grade Degenerative Spondylolisthesis.

Cheung JP, Cheung PW, Cheung KM, Luk KD - Asian Spine J (2016)

Bottom Line: From the results of the short-term, mid-term and long-term follow-up, reoperation only occurred within the first 5-year follow-up period.All functional scores improved from preoperative to postoperative 1-year follow-up.Further higher-level studies should be performed on this patient group with radiological instability to suggest the superior surgical option.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, SAR, China.

ABSTRACT

Study design: Retrospective series.

Purpose: Assess results of decompression-only surgery for low-grade degenerative spondylolisthesis with consideration of instability.

Overview of literature: There is no consensus on whether fusion or decompression-only surgery leads to better outcomes for patients with low-grade degenerative spondylolisthesis. Current trends support fusion but many studies are flawed due to over-generalization without consideration of radiological instability and their variable presentations and natural history.

Methods: Patients with surgically treated degenerative spondylolisthesis from 1990-2013 were included. Clinical and radiological instability measures were included. Any residual or recurrence of symptoms, revision surgery performed and functional outcome scores including the numerical global rate of change scale, visual analogue scale, and modified Barthel index were measured. Follow-up periods for patients were divided into short-term (<5 years), mid-term (5-10 years) and long-term (>10 years).

Results: A total of 64 patients were recruited. Mechanical low back pain was noted in 48 patients and most (85.4%) had relief of back pain postoperatively. Radiological instability was noted in 4 subjects by flexion-extension radiographs and 12 subjects with prone traction radiographs by increased disc height and reduction of olisthesis and slip angle. From the results of the short-term, mid-term and long-term follow-up, reoperation only occurred within the first 5-year follow-up period. All functional scores improved from preoperative to postoperative 1-year follow-up.

Conclusions: Decompression-only for low-grade degenerative spondylolisthesis has good long-term results despite instability. Further higher-level studies should be performed on this patient group with radiological instability to suggest the superior surgical option.

No MeSH data available.


Related in: MedlinePlus

Measurement of disc height.
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Figure 3: Measurement of disc height.

Mentions: Radiological instability was defined by evidence of increased degree of slip, change in slip angle and disc height on preoperative flexion-extension radiographs. Instability was also defined by a reduced degree of slip, change in slip angle and disc height on preoperative prone traction radiographs as described by Luk et al. [10]. For prone traction films, patients were placed prone on a traction table and a traction force half of the body weight was applied through a set of chest and pelvic straps before cross-table lateral radiographs were taken. For measurement of the degree of slip (Fig. 1), a line was dropped from the posterior border of the cranial vertebrae to the caudal vertebrae. The distance from this point to the posterior border of the caudal vertebrae was divided by the total vertebral body width of the caudal vertebrae. Change of 4 mm in translation was considered instability. The slip angle of a L5–S1 spondylolisthesis was measured by a line perpendicular to the posterior aspect of sacrum and line drawn along inferior end of the endplate of L5. In cranial segments (Fig. 2), the angle was made by the superior endplate of caudal vertebrae and inferior endplate of cranial vertebrae. Taking into account for measurement errors usually present for measuring angles [11], changes of slip angle >5° was considered unstable. For measurement of the disc height (Fig. 3), a line was dropped from the midline inferior endplate of the cranial vertebrae to the upper endplate of the caudal vertebrae. A ratio between this distance and the midline vertebral height of the cranial vertebrae was compared on dynamic views. Normal Asian lumbar spine disc profiles [1213] of gradual increase from L1–L2 to L4–L5 followed by decrease to L5–S1 was used as the baseline comparison. Any change in this relationship was considered unstable. In prone traction films, immediate change in disc height was evidence that the anterior column supporting axial compression was deficient. Currently, there is no consensus on what is considered instability on the prone traction films. Thus, similar to flexion-extension radiographs, any increase in disc height, reduction of olisthesis or reduction of slip angle was noted in the prone traction radiographs for the purposes of this study.


Decompression without Fusion for Low-Grade Degenerative Spondylolisthesis.

Cheung JP, Cheung PW, Cheung KM, Luk KD - Asian Spine J (2016)

Measurement of disc height.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4764545&req=5

Figure 3: Measurement of disc height.
Mentions: Radiological instability was defined by evidence of increased degree of slip, change in slip angle and disc height on preoperative flexion-extension radiographs. Instability was also defined by a reduced degree of slip, change in slip angle and disc height on preoperative prone traction radiographs as described by Luk et al. [10]. For prone traction films, patients were placed prone on a traction table and a traction force half of the body weight was applied through a set of chest and pelvic straps before cross-table lateral radiographs were taken. For measurement of the degree of slip (Fig. 1), a line was dropped from the posterior border of the cranial vertebrae to the caudal vertebrae. The distance from this point to the posterior border of the caudal vertebrae was divided by the total vertebral body width of the caudal vertebrae. Change of 4 mm in translation was considered instability. The slip angle of a L5–S1 spondylolisthesis was measured by a line perpendicular to the posterior aspect of sacrum and line drawn along inferior end of the endplate of L5. In cranial segments (Fig. 2), the angle was made by the superior endplate of caudal vertebrae and inferior endplate of cranial vertebrae. Taking into account for measurement errors usually present for measuring angles [11], changes of slip angle >5° was considered unstable. For measurement of the disc height (Fig. 3), a line was dropped from the midline inferior endplate of the cranial vertebrae to the upper endplate of the caudal vertebrae. A ratio between this distance and the midline vertebral height of the cranial vertebrae was compared on dynamic views. Normal Asian lumbar spine disc profiles [1213] of gradual increase from L1–L2 to L4–L5 followed by decrease to L5–S1 was used as the baseline comparison. Any change in this relationship was considered unstable. In prone traction films, immediate change in disc height was evidence that the anterior column supporting axial compression was deficient. Currently, there is no consensus on what is considered instability on the prone traction films. Thus, similar to flexion-extension radiographs, any increase in disc height, reduction of olisthesis or reduction of slip angle was noted in the prone traction radiographs for the purposes of this study.

Bottom Line: From the results of the short-term, mid-term and long-term follow-up, reoperation only occurred within the first 5-year follow-up period.All functional scores improved from preoperative to postoperative 1-year follow-up.Further higher-level studies should be performed on this patient group with radiological instability to suggest the superior surgical option.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, SAR, China.

ABSTRACT

Study design: Retrospective series.

Purpose: Assess results of decompression-only surgery for low-grade degenerative spondylolisthesis with consideration of instability.

Overview of literature: There is no consensus on whether fusion or decompression-only surgery leads to better outcomes for patients with low-grade degenerative spondylolisthesis. Current trends support fusion but many studies are flawed due to over-generalization without consideration of radiological instability and their variable presentations and natural history.

Methods: Patients with surgically treated degenerative spondylolisthesis from 1990-2013 were included. Clinical and radiological instability measures were included. Any residual or recurrence of symptoms, revision surgery performed and functional outcome scores including the numerical global rate of change scale, visual analogue scale, and modified Barthel index were measured. Follow-up periods for patients were divided into short-term (<5 years), mid-term (5-10 years) and long-term (>10 years).

Results: A total of 64 patients were recruited. Mechanical low back pain was noted in 48 patients and most (85.4%) had relief of back pain postoperatively. Radiological instability was noted in 4 subjects by flexion-extension radiographs and 12 subjects with prone traction radiographs by increased disc height and reduction of olisthesis and slip angle. From the results of the short-term, mid-term and long-term follow-up, reoperation only occurred within the first 5-year follow-up period. All functional scores improved from preoperative to postoperative 1-year follow-up.

Conclusions: Decompression-only for low-grade degenerative spondylolisthesis has good long-term results despite instability. Further higher-level studies should be performed on this patient group with radiological instability to suggest the superior surgical option.

No MeSH data available.


Related in: MedlinePlus