We made a retrospective study of 149 children and adolescents with moderate spondylolisthesis. (slip. 30%),. 77 treated by fusion and 72 conservatively.
OPERATIVE
AND
MODERATE
CONSERVATIVE
SPONDYLOLISTHESIS
IN
SEPPO
From
30%), fully
the Orthopaedic
We made a retrospective 77 treated by fusion comparable The patients
progression
TREATMENT
and
with regard who were
ofthe
study of 149 children 72 conservatively
of the slip. They had better
clinical
YOUNG
PATIENTS
SEITSALO
Hospital
to age at diagnosis, treated operatively
OF
Invalid
Foundation,
Helsinki
and adolescents with moderate at an average follow-up of 13.3 sex distribution had more pain
results
spondylolisthesis (slip years. Both groups were
(46% girls), and mean before treatment and
and less pain at latest
review,
slip. showed
more
but the total
initial
progression
of the slip over the whole follow-up showed no statistical differences between the two groups. Patients with a pseudarthrosis after attempted fusion had had a longer period of postoperative pain, but at the latest review had no more pain than those with sound fusion. None of those treated conservatively came to fusion later and the long-term results in 18 patients who had refused the advised operation were no worse than those conservatively treated patients. Our results suggest that a moderate grade of spondylolisthesis in adolescents usually has course. It seems level of the slip.
that
spontaneous
The
indications
for the operative
and
adolescents
with
spondylolisthesis
pain
resistant
persistent
back
radiating with a
pain, tightness spondylolisthetic
segmental
treatment
of children
have
usually
to conservative
of the hamstrings crisis, and,
stabifisation
been
treatment, in connection in symptomless
patients, a predicted or real increase in slipping (Wi!tse and Hutchinson 1964; Dandy and Shannon 1971 ; Turner and Bianco 1971 ; Laurent and Osterman 1976 ; Boxa!! et a! 1979). A slip of 30% or more has been considered to indicate likely progression in adolescent patients (Wi!tse and the
Hutchinson 1964; Laurent and Osterman natural history of the condition has
reported. Several
treatment have
studies
report
by fusion
presented
with
the
the
outcome
or without
results
of
1976), but been rarely of
operative
reduction,
conservative
but
few
is ofthe
opinion
that
conservative
as a result
better Zippe!
results (1980)
Correspondence D7,02160
©
should Espoo,
1990 British 0301-620X/90/S
J Bone Joint
908
be sent
treatment
gives
in the
The present
compares
at Liinasaarenkuja
Finland. Joint
of symptoms
results
operative treatment in children a 30% slip, even in symptom!ess
in young
and
patients
and adolescents has been patients, because of the
assumed high risk of further progression. considered essential to compare patients 30% slip, focusing on the factors which treatments long-term
and the follow-up.
clinical
PATIENTS In all, under
220 consecutive the
and
It was therefore with less than led to different
radiological
age
Surgery
3-5
of
AND
METHODS
patients
with
20 years
were
Orthopaedic Hospital of the 1948 to 1980. Of these, 190
to attend
Editorial Society of Bone and I 72 $2.00 Surg[Br]1990; 72-B :908-13.
study
severity
fusion, but conclusions,
with established, moderate spondy!o!isthesis, one group having been treated by fusion and the other by conservative or no treatment. An established indication for
review A total
conservatively
Surgeon to Dr S. Seitsalo
a benign
of the disc at the
than, for example, anterior warns against simplified
because of differences the degree of slipping.
radiological first visit. S. Seitsalo, MD, Orthopaedic Jorvi Hospital, Espoo, Finland.
of degeneration
results
at
treatment
(Pfei! 1975; Gramse, Sinaki and I!strup 1980; Ede!mann 1984; Steiner and Micheli 1985; Wi!!ner 1985) except briefly in connection with operative results (Laurent and Einola 1961 ; Turner and Bianco 1971 ; Savastano and Navach 1972; B!ackburne and Velikas 1977). Tai!!ard (1954)
occurs
for other
Invalid (86%)
upon
at
Foundation had a clinical
the from and
at an average of 14.5 years after their of 100 consecutive patients treated
during
for
spondy!o!isthesis
operated
follow-up
the
same
period
examination,
were
also
and
82 of them
invited
complied. The patients selected for surgery had a significantly higher percentage slip at the time of diagnosis (mean 45.2 ± 29.2%) than the patients treated conservatively THE
JOURNAL
OF BONE
AND
JOINT
SURGERY
OPERATIVE
AND
CONSERVATIVE
Table I. Clinical and radiological conservatively and the operatively spondylolisthesis
findings treated
TREATMENT
at the groups
first visit of patients
OF MODERATE in
the with
SPONDYLOLISTHESIS
(46%).
The
average
presentation
percentage
were
also
Operative (n = 77)
Significance of difference
Age (yr, mean ± s.d.)
13.8 ± 3.6
14.6 ± 3.0
NS
slip
Sex-ratio(ofgirls
46
46
NS
patients, a!! the others of the operated group
Slip (%, mean
± s.d.)
16.2±
pain
(%)
Radiating
pain
(#{176}/)
Low
and
Low
back
back
Tightness *
16.6
radiating
leg raising
N5
± 7.6
92
NS
8
43
p
