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Abstract from the SRS 2001 Annual Meeting
P.J. Kelty, B.S.
A.H. Crawford, M.D.
C.T. Mehlman, D.O.,M.P.H. Children's Hospital Medical
Center Cincinnati, Cincinnati, Ohio, USA PURPOSE: To evaluate the effectiveness
of a surgical protocol involving a midline posterior fusion with autogenous
bone graft and postoperative reduction and immobilization for children and adolescents
with spondylolisthesis. MATERIALS & METHODS: Between 1978 & 2000 49 pts with
spondylolisthesis were treated via the surgical protocol being studied. Eight
of these pts were excluded because they lacked 2-yr follow-up, although none
have developed a pseudarthrosis or any other complications to date. Two of the
41 patients included in the present study had a pseudarthrosis from a previous
fusion attempt by another surgeon and were later successfully fused by this
study's protocol. All of the patients were operated by one surgeon (AHC) at
the same institution between 1978 and 1998. FINDINGS: The study population included
20 males and 21 females, with a mean age at the time of surgery of 14 yrs 4
mo (range=6 yrs 9 mo-20 yrs 9 mo). Mean clinical follow-up was 11 yrs 6 mo (range=3
yrs 1 mo-21 yrs 8 mo). 25 pts were Meyerding Grade I or II and 16 pts were Grade
III or higher. 10 pts also underwent decompression in conjunction with their
fusion procedure. 37 pts were fused from L4-S1 & 4 pts were fused from L3-S1.
Pts were immobilized postoperatively for an avg of 8 wks (range= 4 wks-12 wks)
in a double pantaloon spica cast that was usually later converted to a TLSO
with a single thigh extension. There were 4 surgical complications in 3 pts.
3 pts had an infection of the surgical wound, 2 requiring surgical I&D and 1
only dressing changes. One pt (2.4%) had a radiographically evident pseudarthrosis.
This patient has declined repeat surgery because she was, and continues to be,
asymptomatic. No perioperative nerve-related complications occurred. At an avg
radiographic follow-up of 4 yrs 81% of pts demonstrated either % slip stability
or at least 5% improvement and 69% demonstrated either slip angle stability
or 5o improvement. 58% (24/41) of pts were contacted and completed a telephone
interview. 88% (21/24) reported mild or no pain in their lumbosacral spine.
75% (18/24) described their activity level as either somewhat active or very
active. If given the chance 96% (23/24) of pts said they would choose to have
the same surgery again. SIGNIFICANCE: Our surgical protocol has been shown to
be highly effective (97.6% fusion rate) with high satisfaction (96% would choose
again) and an acceptably low rate of complications (7% infection & 0% nerve
injury). We feel that any new technique applied to the treatment of such pediatric
spondylolisthesis pts should meet or exceed results such as ours.
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