A critical analysis of the literature regarding surgical approach and outcome for adult low-grade isthmic spondylolisthesis.
OBJECTIVE
A systematic review of the radiographic and clinical outcomes of adult patients undergoing surgery for low-grade isthmic spondylolisthesis was performed to determine whether conclusions could be made regarding the optimal choice of surgically managing adult low-grade isthmic spondylolisthesis.


METHODS
We tabulated the radiographic and clinical outcomes of patients who underwent a posterior procedure alone, an anterior procedure alone, or a combined anterior and posterior procedure. We also evaluated the influence of covariates such as laminectomy, spinal internal fixation, smoking, and secondary gain issues on these outcomes. Patients were pooled, and a chi analysis was performed to determine the relationship between surgical approach and patient outcome. A covariate analysis was performed to determine the influence of a laminectomy, spinal fixation, smoking, and secondary gain issues on these outcomes.


RESULTS
The available literature consisted primarily of retrospective case series, with only 4 of 34 reports being prospective randomized controlled studies. Patients with combined anterior and posterior procedures were most likely to achieve a solid fusion and a successful clinical outcome. The use of spinal fixation also increased the chance of fusion and successful clinical outcome.


CONCLUSIONS
A pooling of the surgical literature on adult low-grade spondylolisthesis indicates that a combined anterior and posterior procedure most reliably achieves fusion and a successful clinical outcome. The literature, however, is primarily retrospective and heterogeneous with respect to indications for surgery and methods of evaluating outcome, providing a compelling rationale for a prospective randomized controlled trial of the various surgical approaches to this problem.
Kwon
Brian K
BK
Gowan and Michele Guest Neuroscience Canada Foundation/CIHR, International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada. briankkwon@yahoo.ca
Hilibrand
Alan S
AS
Malloy
Kelly
K
Savas
Paul E
PE
Silva
Marco T
MT
Albert
Todd J
TJ
Vaccaro
Alexander R
AR
D000328:Adult; D000704:Analysis of Variance; D015984:Causality; D006801:Humans; D016268:Internal Fixators / Q000706:statistics & numerical data / Q000639:trends; D007796:Laminectomy / Q000706:statistics & numerical data / Q000639:trends; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D016239:MEDLINE; D011859:Radiography; D016032:Randomized Controlled Trials as Topic / Q000592:standards; D012189:Retrospective Studies; D012907:Smoking / Q000639:trends; D013123:Spinal Fusion / Q000379:methods / Q000706:statistics & numerical data* / Q000639:trends*; D013168:Spondylolisthesis / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome