OBJECTIVE: Adult isthmic spondylolisthesis can be treated with direct repair of the defect, decompression (alone or with posterolateral fusion), circumferential fusion, and reduction with posterior fixation. The aim of this work is to assess the mid-term results of decompression and in situ fusion among patients undergoing surgical treatment with the same surgeon. METHOD: Inclusion criteria: 1) L5-S1 Isthmic spondylolisthesis. 2) Surgery performed after skeletal maturity. 3) L5 laminectomy and arthrectomy with posterolateral instrumented fusion without reduction. 4) Follow-up greater than 3 years. 5) No pseudoarthrosis at follow-up. 6) Functional and radiological assessment by independent observers; literature review and data comparison; statistical analysis with t-test, chi-squared and ANOVA. RESULTS: 16 patients were evaluated (12 ♀/4 ♂). Mean age: 40.6 years (17-66); mean follow-up: 10.3 years (3.3-18). Average slip: 42.9%. Nine patients had radicular pain, 3 back pain and 4 both. Mean preoperative SRS pain score: 1.38 with no differences between low and high degree (p=0.887). Fifteen of 16 patients had improvement of symptoms (mean final score: 4.44). Thirteen of 16 patients returned to previous activity (81%). There were 2 infections, but no neurologic complications. The spino-pelvic parameters at the end of the follow-up showed no statistical differences compared with the values found in literature. The comparison between low and high degree listhesis in our series showed no significant difference in these parameters or in the follow-up period, fused levels, symptoms or return to work. CONCLUSION: The posterolateral decompression and instrumented fusion in situ allow 80% of good results in lumbosacral isthmic spondylolisthesis in adults regardless of the degree of slip.
Spondylolisthesis, Surgery; Arthrodesis; Laminectomy; Spinal fusion
