Posterolateral, anterior, or circumferential fusion in situ for high-grade spondylolisthesis in young patients:: A long-term evaluation using the Scoliosis Research Society questionnaire

Study Design. 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. Summary of Background Data. 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 ( >= 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 ( >= 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.