title: Minimum 5-year results of degenerative spondylolisthesis treated with decompression and instrumented posterior fusion.
abstract: METHODS
  An analysis of consecutive cases of degenerative spondylolisthesis treated by one of two surgeons at a university hospital.
  
  
  OBJECTIVE
  To assess at a minimum 5-year follow-up the complication rate, reoperation rate, radiographic results, and patient satisfaction with surgical treatment of lumbar degenerative spondylolisthesis by means of segmental posterior instrumented fusion with decompression.
  
  
  BACKGROUND
  No reports of minimum 5-year follow-up for surgical treatment of degenerative spondylolisthesis were found in the literature.
  
  
  METHODS
  The potential study population consisted of 49 consecutive patients who had undergone no prior surgery for degenerative spondylolisthesis (average age, 66.7 years; range, 52.2-78.7 years) with mean follow-up of 6.5 years (range, 5-10.75 years) who were treated with decompression, autogenous iliac crest bone grafting, intertransverse process fusion, and segmental (pedicle screw) instrumentation. Eight patients had died; the remaining 41 were included in the study sample. Thirty-six (88%) of the 41 patients returned an outcome questionnaire and had current radiographs.
  
  
  RESULTS
  There was one case of instrument failure (one broken screw with late fusion), and one superficial infection. There were no neurologic deficits, no pseudarthroses, no recurrent stenosis at the fused segment, and no progression of deformity at the fused level. Five patients had symptomatic adjacent level transition syndromes. There were seven additional currently asymptomatic radiographic transition syndromes. Segmental sagittal Cobb angles were maintained at the fused level (17.7 +/- 8-18.8 +/- 7 degrees). Eighty-three percent reported satisfaction with the procedure, 86% thought their back and leg pain was still significantly better than before surgery, and 77% would have the procedure again if needed. Poor satisfaction (n = 4) was associated with more than four medical comorbidities (P < 0.03). A significant number (12 of 49, 24%) of patients had died or were ill more than 5 years after surgery.
  
  
  CONCLUSIONS
  Radiographic transition syndromes were common. Major complications (2%), implant failures (2%), and symptomatic pseudarthroses (0%) were low.
authors.affiliation: Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: K C
authors.initials: KC
authors.lastname: Booth
authors.forename: K H
authors.initials: KH
authors.lastname: Bridwell
authors.forename: B A
authors.initials: BA
authors.lastname: Eisenberg
authors.forename: C R
authors.initials: CR
authors.lastname: Baldus
authors.forename: L G
authors.initials: LG
authors.lastname: Lenke
mesh_terms: D000368:Aged; D019299:Decompression, Surgical; D006801:Humans; D008875:Middle Aged; D009984:Orthopedic Fixation Devices; D010146:Pain / Q000503:physiopathology; D017060:Patient Satisfaction; D011184:Postoperative Period; D011859:Radiography; D013123:Spinal Fusion; D013168:Spondylolisthesis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome