title: Quality of life of patients with high-grade spondylolisthesis: minimum 2-year follow-up after surgical and nonsurgical treatments.
abstract: BACKGROUND
  Surgical intervention is generally indicated in a pediatric high-grade spondylolisthesis to prevent the progression of deformity or neurologic deterioration and improve the quality of life. However, the outcome of the treatment on the health-related quality of life (HRQOL) of patients with high-grade spondylolisthesis remains largely unknown.
  
  
  OBJECTIVE
  To describe the changes in the HRQOL of patients with pediatric high-grade spondylolisthesis after surgical and nonsurgical managements.
  
  
  METHODS
  Observational case series with a minimal of 2-year follow-up.
  
  
  METHODS
  Twenty-eight pediatric patients with high-grade spondylolisthesis from a single institution filled the inclusion criteria. Twenty-three patients were managed surgically and five were managed nonsurgically.
  
  
  METHODS
  Self-report measures: Scoliosis Research Society questionnaires (SRS-22). Neurologic examination, radiographic evaluation of slip grade.
  
  
  METHODS
  The SRS-22 questionnaire was collected at the baseline (initial presentation for the nonsurgical group and preoperative visit for the surgical group) and at the last follow-up. Differences between baseline and last follow-up were evaluated in both groups. Correlation between the baseline score of SRS-22 score and improvement in the SRS-22 score was determined in surgical patients.
  
  
  RESULTS
  In surgical patients, total SRS-22 scores were 3.31 ± 0.50 at the baseline and 4.26 ± 0.50 at the last follow-up. In nonsurgical patients, total SRS-22 scores were 4.12 ± 0.16 at the baseline and 4.14 ± 0.38 at the last follow-up. Therefore, variation in the SRS-22 total score was +0.94 ± 0.77 (p<.001) for surgical patients and +0.02 ± 0.35 (p=.854) for nonsurgical patients. Improvement of the SRS-22 score was correlated with a low baseline value of SRS-22 (R²=0.61; p<.001). There was no neurologic or slip deterioration during the follow-up for patients treated nonsurgically.
  
  
  CONCLUSIONS
  The HRQOL improves after a surgical intervention for high-grade spondylolisthesis. Patients with lower baseline HRQOL scores are those who benefit the most from surgery. Close observation is a safe and feasible option in selected patients with a good baseline HRQOL and no neurologic impairment.
authors.affiliation: Faculty of Medicine, University of Montreal, 2900 Boulevard Edouard-Montpetit Montreal, QC H3T 1J4, Canada. etienne.bourassamoreau@gmail.com
authors.forename: Étienne
authors.initials: É
authors.lastname: Bourassa-Moreau
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Mac-Thiong
authors.forename: Julie
authors.initials: J
authors.lastname: Joncas
authors.forename: Stefan
authors.initials: S
authors.lastname: Parent
authors.forename: Hubert
authors.initials: H
authors.lastname: Labelle
mesh_terms: D000293:Adolescent; D019299:Decompression, Surgical; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D017060:Patient Satisfaction; D011788:Quality of Life; D057566:Self Report; D012720:Severity of Illness Index; D013123:Spinal Fusion; D013168:Spondylolisthesis / Q000601:surgery / Q000628:therapy*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult
keywords: Case series; Health-related quality of life; Lumbar fusion; SRS-22 questionnaire; Spondylolisthesis