title: Predictors of outcomes after posterior decompression and fusion in degenerative spondylolisthesis.
abstract: No consensus has been reached regarding surgical management of degenerative spondylolisthesis. The optimal type of surgical procedure and surgical indications have not been precisely defined. In order to screen for predictors of outcome, we retrospectively studied patient outcomes after posterior decompression and fusion for isolated lumbar degenerative spondylolisthesis. Twenty-four consecutive patients (age range 50-78 years) underwent primary surgery for isolated lumbar degenerative spondylolisthesis. The surgical procedure consisted of posterior decompression and pedicle screw instrumented fusion using autogeneous bone graft, with or without interbody fusion. Clinical and radiologic status were assessed using the Beaujon functional score and plain AP and lateral radiographs. A multivariate analysis was used to correlate the functional score increase with surgical procedure modifications and preoperative clinical and radiologic features in order to determine which of them led to better results. Eighteen patients completed the evaluation. Six others were lost to follow-up after a minimum of 0.87 years. Combining all the results, the mean follow-up was 2.87 years. The Beaujon score was improved in the 24 patients (P<0.001), and fusion was successful in all cases. Additional interbody fusion and preoperative leg pain were significantly correlated with larger score increase (P=0.016 and P=0.003). Posterior decompression and fusion is successful in treating lumbar degenerative spondylolisthesis. From this study, circumferential fusion improves the outcomes and leg pain is a fair indication for surgery.
authors.affiliation: Service de Chirurgie Orthopédique et Traumatologique, Hôpital Pitié-Salpétrière, 47 Boulevard de l'Hôpital 75013, Paris, France.
authors.forename: Marc-Antoine
authors.initials: MA
authors.lastname: Rousseau
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Lazennec
authors.forename: Elisa C
authors.initials: EC
authors.lastname: Bass
authors.forename: Gérard
authors.initials: G
authors.lastname: Saillant
mesh_terms: D000368:Aged; D001863:Bone Screws / Q000009:adverse effects / Q000706:statistics & numerical data; D016025:Bone Transplantation / Q000009:adverse effects / Q000706:statistics & numerical data; D015984:Causality; D019299:Decompression, Surgical / Q000295:instrumentation / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016268:Internal Fixators / Q000009:adverse effects / Q000706:statistics & numerical data; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018579:Patient Selection; D011859:Radiography; D012189:Retrospective Studies; D012584:Sciatic Nerve / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods / Q000706:statistics & numerical data*; D013168:Spondylolisthesis / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome