Reduction Versus Non-Reduction Technique in Low Grade Spondylolisthesis; Functional Outcome
Iraqi Postgraduate Medical Journal,
2014, Volume 13, Issue 1, Pages 115-121
Spondylolisthesis is a condition in which a vertebra slips anteriorly in relation to the vertebra below as a result of pars defect or degenerative disease. The slipped segment produces abnormal positioning of the vertebrae in relation to each other along the spinal column that causing back pain and neurologic deficit.
There are debates about surgical maneuvers regarding low grade spondylolisthesis (grades I and II according to Meyerding classification) whether to reduce the slipped segment or not, the aim of this study is to determine the short and long term difference in the functional outcome between these methods.
PATIENTS AND METHODS:
This randomized prospective study consist of 32 patients aged between 42-63 years old (11 males and 21 females) treated for symptomatic low grade spondylolisthesis between October 2009 to November 2011 and followed up for 24 months. All patients were randomly divided into two groups: Group I (15 patients) underwent surgical reduction of the slipped segment, and Group II (17 patients) who underwent in-situ fusion without reduction. Both groups had the same pre and postoperative management.
Early postoperative minor complications including one case in each group had superficial wound infection (6.6% and 5.8% in Group I and II respectively) which was controlled in the hospital, and one case in each group (6.6% and 5.8% in Group I and II respectively) had dural tear intraoperatively that was repaired during the operation; none of patients had CSF leak postoperatively. There were two cases in Group I (13.3%) and one case in Group II (5.8%) had postoperative transient sciatic pain due to nerve irritation. Depending on the Oswestry Disability Index (ODI), there was a significant statistical difference between both groups in the short term (p-value = 0.04), but there was no significant statistical difference in the long term follow up between them (p-value =0.33) regarding the functional outcome.
Surgical treatment of low grade symptomatic spondylolisthesis usually include neural decompression, fixation and fusion; however reduction of the slipped segment is not necessary for these patients as the ultimate outcome is similar to those who underwent in-situ fusion only.
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