title: Posterolateral, anterior, or circumferential fusion in situ for high-grade spondylolisthesis in young patients: a long-term evaluation using the Scoliosis Research Society questionnaire.
abstract: METHODS
  A retrospective, comparative follow-up study.
  
  
  OBJECTIVE
  To compare clinical and radiographic outcomes after posterolateral, anterior, or circumferential fusion in situ for high-grade spondylolisthesis in children and adolescents.
  
  
  BACKGROUND
  Controversial opinions still exist about the surgical treatment of severe isthmic spondylolisthesis. There are no long-term comparative studies of different fusion in situ techniques in these patients.
  
  
  METHODS
  A total of 21 patients treated using posterolateral, 23 using anterior, and 26 using the circumferential fusion technique without instrumentation for high-grade isthmic spondylolisthesis (>or=50% slip) participated. Their mean age at surgery was 14.4 years (range 8.0-19.6). The follow-up rate was 84% after a mean of 17.2 years (range 10.7-26.0). Radiographs were obtained before surgery, at 2-year follow-up, and at final follow-up. The Scoliosis Research Society (SRS) and Oswestry Disability Index questionnaires were completed, and a physical examination was performed at the final follow-up visit.
  
  
  RESULTS
  Progression of lumbosacral kyphosis (>or=10 degrees ) was found in 9 (43%), 3 (13%), and 3 (12%) patients of the posterolateral, anterior, and circumferential fusion groups, respectively (P = 0.017). The SRS total score averaged 89.7 (range 56-105) in the posterolateral, 93.2 (range 66-114) in the anterior, and 100.0 (range 71-117) in the circumferential fusion groups (P = 0.021). Patients in the circumferential fusion group had better values for pain (P = 0.023) and function from back condition domains (P = 0.079) than patients in the posterolateral or anterior groups. The Oswestry Disability Index averaged 9.7 (range 0-62) in the posterolateral, 8.9 (range 0-32) in the anterior, and 3.0 (range 0-16) in the circumferential fusion groups (P = 0.035).
  
  
  CONCLUSIONS
  Circumferential fusion provided significantly better long-term clinical, radiographic, and SRS total score than posterolateral or anterior fusion for high-grade isthmic spondylolisthesis.
authors.affiliation: ORTON Orthopaedic Hospital, Invalid Foundation, Finland. ilkka.helenius@helsinki.fi
authors.forename: Ilkka
authors.initials: I
authors.lastname: Helenius
authors.forename: Tommi
authors.initials: T
authors.lastname: Lamberg
authors.forename: Kalevi
authors.initials: K
authors.lastname: Osterman
authors.forename: Dietrich
authors.initials: D
authors.lastname: Schlenzka
authors.forename: Timo
authors.initials: T
authors.lastname: Yrjönen
authors.forename: Pekka
authors.initials: P
authors.lastname: Tervahartiala
authors.forename: Seppo
authors.initials: S
authors.lastname: Seitsalo
authors.forename: Mikko
authors.initials: M
authors.lastname: Poussa
authors.forename: Ville
authors.initials: V
authors.lastname: Remes
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D004185:Disability Evaluation; D005260:Female; D005387:Finland; D005500:Follow-Up Studies; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging; D008297:Male; D011859:Radiography; D012189:Retrospective Studies; D012447:Sacrum / Q000000981:diagnostic imaging; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology; D012955:Societies, Medical; D013123:Spinal Fusion / Q000592:standards; D013168:Spondylolisthesis / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology; D011795:Surveys and Questionnaires; D013997:Time Factors