title: Factors affecting clinical outcomes in treating patients with grade 1 degenerative spondylolisthesis using interspinous soft stabilization with a tension band system: a minimum 5-year follow-up.
abstract: METHODS
  Retrospective clinical study.
  
  
  OBJECTIVE
  To explore the factors influencing the clinical outcomes and motion-preserving stabilization after interspinous soft stabilization (ISS) with a tension band system for grade 1 degenerative spondylolisthesis (DS).
  
  
  BACKGROUND
  Despite increasing recognition of the benefits of dynamic stabilization systems for treating lumbar degenerative disorders, the factors affecting the clinical and radiological outcomes of these systems have rarely been identified.
  
  
  METHODS
  Sixty-five patients (mean age, 60.3 years) who underwent ISS with a tension band system between 2002 and 2004 were analyzed. The mean follow-up period was 72.5 months. The patients were divided according to the postsurgical clinical improvements into the optimal (n = 44) and suboptimal groups (n = 21), and the radiological intergroup differences were analyzed. Multiple linear regression analysis was performed to determine the impact of the radiological factors on the clinical outcomes.
  
  
  RESULTS
  Significant intergroup differences were observed on the follow-up clinical examination. Radiologically, total lumbar lordosis (TLL) and segmental lumbar lordosis (SLL) were significantly improved only in the optimal group, resulting in significant intergroup differences in TLL (P = 0.023), SLL (P = 0.001), and the L1 tilt (P = 0.002). All these measures were closely associated with postoperative segmental lumbar lordosis, which also was the most influential radiological variable for the clinical parameters.
  
  
  CONCLUSIONS
  In the patients with grade 1 DS, the back pain relief and functional improvement following ISS were affected by the improvements in the sagittal spinal alignment through the achievement of segmental lumbar lordosis. ISS can be an alternative treatment to fusion surgery for grade 1 DS in patients who do not require fixation or reduction.
authors.affiliation: Department of Neurosurgery, Wooridul Spine Hospital, Seoul, Korea.
authors.forename: Sang-Ho
authors.initials: SH
authors.lastname: Lee
authors.forename: June-Ho
authors.initials: JH
authors.lastname: Lee
authors.forename: Soon-Woo
authors.initials: SW
authors.lastname: Hong
authors.forename: Chan Shik
authors.initials: CS
authors.lastname: Shim
authors.forename: Seung-Eun
authors.initials: SE
authors.lastname: Chung
authors.forename: Seung-Hwa
authors.initials: SH
authors.lastname: Yoo
authors.forename: Ho-Yeon
authors.initials: HY
authors.lastname: Lee
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008141:Lordosis / Q000000981:diagnostic imaging / Q000601:surgery; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008161:Lumbosacral Region / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures; D010147:Pain Measurement; D011859:Radiography; D013168:Spondylolisthesis / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome