Hamid Behtash, Ebrahim Ameri, Mohamadsaleh Ganjavian, Farzad Omidi-Kashani, Marzieh Nojomi,
Volume 22, Issue 4 (2-2009)
Abstract
Background: Spondylolysis and spondylolisthesis can be associated with significant
low back pain, especially in physically active adolescents. Non-operative management
is usually successful in improving symptoms, but surgical intervention is
occasionally required. The aim of this study was to determine the effect of in situ posterolateral
fusion in the treatment of refractory cases with spondylolysis.
Methods: In this prospective before and after study, we described our experience
in13 patients managed by in situ fusion after failing multimodality non-operative
treatment. All surgical procedures were performed by the senior author and by a similar
technique. The spondylolytic vertebra and the one below were fused, in situ. Finally,
clinical outcome and recovery rates of clinical symptoms were evaluated by
Henderson’s functional capacity and Oswestry Disability Index version 2.1, respectively.
Results: The mean duration of non-operative management was 36 (12-72)
months. There were 8 males and 5 females. Average pre- and postoperative Oswestry
Disability Indices were 28.4%±13.7% and 4.9±7.8 respectively (P=0.001, significant).
All patients had follow-up contact on an average of 42.3 months (range 30 - 62
months). Based on Henderson’s clinical outcome functional capacity at the final follow-
up stage clinical outcomes were excellent in 10, good in 2 and poor in 1 patient.
The case with poor result had a pseudoarthrosis and was re-oprated. Finally he had an
excellent outcome.
Conclusion: We accept that the number of our cases is not high significantly but it
can be claimed that in situ fusion is a safe and effective modality to treat symptomatic
patients with spondylolysis and low-grade spondylolisthesis. A study with much
more cases is strongly recommended.
