Abstract
Introduction: Spondylolytic spondylolisthesis is a not uncommon cause of back pain in adults. The initial management, especially for the low grade slips, is usually conservative. When this fails or is deemed inadequate surgical options are considered. The principles of surgical treatment involve a fusion of the painful segment or segments (usually with instrumentation), with an associated decompression if there is radicular leg pain. Some authors also propose a simultaneous reduction of the slip. Most reports in the literature on adults have a short follow-up.
Materials and method: This paper reports the results of surgery from two centres carried out between 1993 and 1998 on 75 adult patients using the same indication for surgery and the same surgical technique. The indication for surgery was a significant reduction in the quality of life with persistent low back and/or leg pain after conservative treatment for a minimum of six months. The surgery involved an in situ posterolateral fusion with pedicular fixation (Oswestry system) with a simultaneous decompression for radicular involvement. The average operating time was 2.5 hours (range 2–4) and the average blood loss 850 mls (range 300–2300). The mean follow-up was 61 months (range 24 to 95).
Results and conclusion: A solid fusion was considered to be present in 71 of the 75 cases (95%) using the Lenke and Bridwell (1997) criteria for radiological union. Seventy-two of the 75 cases (96%) had a very satisfactory clinical outcome (Ricciardi et al 1995). The complications were limited – two superficial wound infections and one deep wound infection which resolved after debridement of the wound. There were no neurological complications.
The authors believe that with careful patient selection an instrumented in-situ posterolateral fusion is a safe and effective operation for symptomatic low grade slips providing good long term results.
Abstracts prepared by Mr J. Dorgan. Correspondence should be addressed to him at the Royal Liverpool Children’s Hospital, Alder Hey, Eaton Road, Liverpool L12 2AP, UK
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