operative and conservative treatment of moderate spondylolisthesis in ...

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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