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Operative treatment of isthmic spondylolisthesis in children: a long-term, retrospective comparative study with matched cohorts

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Abstract

The purpose of the present study was to compare the long-term clinical, functional and radiographic outcomes of young patients operated on before or at the onset of puberty (Children) and those operated on after that (Adolescents). The study group consisted of 298 patients operated on under the age of 20 years; 55 of them were operated on before or at the onset of growth spurt (29 females <12.5 years, 26 males <14.5 years). Preoperative data were retrieved from patients’ records. After mean follow-up of 17 years (10.7–26.3), physical examination, radiographic measurements and functional testing were performed by independent observers. SRS-24, Oswestry Disability Index (ODI), and Visual Analogue Scale (VAS) were utilised to evaluate health-related quality of life. The data were compared between the two age groups in the whole study population and in 41 pairs of patients matched by gender, operative method, severity of preoperative slip, and age at follow-up. Preoperatively, one-third of children did not have significant pain symptoms. They were operated upon for resistant postural anomalies in combination with high risk of slip progression. All of the adolescents had low-back pain as the main clinical symptom. The outcomes were satisfactory in both groups in the whole population (children vs. adolescents; low-grade slip: SRS-24: 95.9 vs. 92.0, ODI: 5.2 vs. 7.5, VAS low-back pain: 18.9 vs. 21.2; high-grade slip: SRS-24: 95.6 vs. 90.6, ODI: 3.4 vs. 6.9, VAS low-back pain: 10.5 vs. 22.1). The differences were statistically significant for ODI and VAS in high-grade patients in favor of the children. The clinical relevance of these differences seems to be minimal. The results of the comparison of the matched cohorts were comparably good. One-fifth of the whole study group had a non-union which did not affect the final outcome. In the children with high-grade slips, there was a mean slip improvement of 14 percentage points due to remodelling. The overall complication rate in the whole population was 7.7%. In conclusion, spinal fusion can be carried out at an early age for low- and high-grade spondylolisthesis with good long-term clinical, functional, radiographic and health-related quality-of-life outcomes when the indications are met.

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References

  1. Alaranta H, Hurri H, Heliövaara M et al (1994) Flexibility of the spine: normative values of goniometric and tape measurements. Scand J Rehab Med 26:147–154

    CAS  Google Scholar 

  2. Alaranta H, Hurri H, Heliövaara M et al (1994) Non-dynamometric trunk performance tests: reliability and normative data. Scand J Rehab Med 26:211–212

    CAS  Google Scholar 

  3. Baker DR, McHolick W (1956) Spondyloschisis and spondylolisthesis in children. J Bone Joint Surg; 38-A:933-34

    Google Scholar 

  4. Bell D, Ehrlich M, Zaleske D (1988) Brace treatment for symptomatic spondylolisthesis. Clin Orthop 236:192–198

    PubMed  Google Scholar 

  5. Beguiristáin JL, Diaz-de-Rada P (2004) Spondylolisthesis in pre-school children. J Pediatr Orthop B 13:225–230

    Article  PubMed  Google Scholar 

  6. Boxall D, Bradford DS, Winter RB et al (1979) Management of severe spondylolisthesis in children and adolescents. J Bone Joint Surg Am 61:479–495

    PubMed  CAS  Google Scholar 

  7. Dubousset J (1997) Treatment of spondylolysis and spondylolisthesis in children and adolescents. Clin Orthop 337:77–85

    Article  PubMed  Google Scholar 

  8. Fairbank JCT, Couper J, Davies JB et al (1980) The Oswestry low back pain disability questionnaire. Physiotherapy 66:271–273

    PubMed  CAS  Google Scholar 

  9. Fredrickson BE, Baker D, McHolick WJ et al (1984) The natural history of spondylolysis and spondylolisthesis. J Bone Joint Surg 66-A:699–707

    Google Scholar 

  10. Haher TR, Gorup JM, Shin TM (1999) Results of the Scoliosis Research Society Instrument for evaluation of surgical outcome in adolescent idiopathic scoliosis. A multicenter study of 244 patients. Spine 24:1435–1440

    Article  PubMed  CAS  Google Scholar 

  11. Helenius I, Lamberg T, Österman K et al (2005) Scoliosis Research Society Outcome Instrument in evaluation of long-term surgical results in spondylolysis and low-grade isthmic spondylolisthesis in young patients. Spine 30:336–341

    Article  PubMed  Google Scholar 

  12. Helenius I, Lamberg T, Österman K et al (2006) Posterolateral, anterior, or circumferential fusion in situ for high-grade spondylolisthesis in young patients: a long-term evaluation using the scoliosis research society questionnaire. Spine 31:190–196

    Article  PubMed  Google Scholar 

  13. Helenius I, Remes V, Poussa M (2008) Uninstrumented in situ fusion for high-grade childhood and adolescent isthmic spondylolisthesis: long-term outcome. Surgical technique. J Bone Joint Surg 90:145–152

    Article  PubMed  Google Scholar 

  14. Laurent LE (1958) Spondylolisthesis. A study of 53 cases treated by spine fusion and 32 cases treated by laminectomy. Acta Orthop Scand 27:1–45

    Google Scholar 

  15. Laurent LE, Einola S (1961) Spondylolisthesis in children and adolescents. Acta Orthop Scand 31:45–64

    Article  PubMed  CAS  Google Scholar 

  16. Laurent LE, Österman K (1976) Operative treatment of spondylolisthesis in young patients. Clin Orthop 117:85–91

    PubMed  Google Scholar 

  17. Lonstein JE (1999) Spondylolisthesis in children: cause, natural history, and management. Spine 24:2640–2648

    Article  PubMed  CAS  Google Scholar 

  18. Pease CN, Najat H (1967) Spondylolisthesis in children Special reference to the lumbosacral joint and treatment by fusion. Clin Orthop 52:187–198

    Article  PubMed  CAS  Google Scholar 

  19. Poussa M, Schlenzka D, Seitsalo S et al (1993) Surgical treatment of severe isthmic spondylolisthesis in adolescents Reduction or fusion in situ. Spine 18:894–901

    Article  PubMed  CAS  Google Scholar 

  20. Poussa M, Remes V, Lamberg T et al (2006) Treatment of severe spondylolisthesis in adolescence with reduction or fusion in situ: long-term clinical, radiologic, and functional outcome. Spine 31:583–590

    Article  PubMed  Google Scholar 

  21. Remes V, Lamberg T, Tervahartiala P et al (2006) Long-term outcome after posterolateral, anterior, and circumferential fusion for high-grade insthmic spondylolisthesis in children and adolescents. Magnetic resonance imaging findings after average of 17-year follow-up. Spine 31:2491–2499

    Google Scholar 

  22. Saraste H, Brostrom LA, Aparisi T (1984) Prognostic radiographic aspects of spondylolisthesis. Acta Radiologica Diagn 25:427–432

    CAS  Google Scholar 

  23. Seitsalo S (1990) Operative and conservative treatment of moderate spondylolisthesis in young patients. J Bone Joint Surg Br 72-B:908–913

    Google Scholar 

  24. Seitsalo S, Österman K, Poussa M et al (1988) Spondylolisthesis in children under 12 years of age: long-term results of 56 patients treated conservatively or operatively. J Pediatr Orthop 8:516–521

    Article  PubMed  CAS  Google Scholar 

  25. Seitsalo S, Österman K, Hyvärinen H et al (1990) Severe spondylolisthesis in children and adolescents. A long-term review of fusion in situ. J Bone Joint Surg Br 72:259–265

    PubMed  CAS  Google Scholar 

  26. Seitsalo S, Österman K, Hyvärinen H et al (1991) Progression of spondylolisthesis in children and adolescents. A long-term follow-up of 272 patients. Spine 16:417–21

    Google Scholar 

  27. Seitsalo S, Schlenzka D, Poussa M, Hyvärinen H, Österman K (1992) Solid fusion vs. non-union in long-term follow-up of in situ fusion without internal fixation in symptomatic spondylolisthesis in young patients. Eur Spine J 1:163–166

    Article  PubMed  CAS  Google Scholar 

  28. Sorva R, Lankinen S, Tolppanen EM, Perheentupa J (1990) Variation of growth in height and weight of children II. After infancy. J Acta Paediatr Scand 79:498–506

    Article  CAS  Google Scholar 

  29. Taillard W (1954) Le spondylolisthesis chez l’enfant et l’adolescent. Etude de 50 cas. Acta Orthop Scand 24:115–144

    Article  PubMed  CAS  Google Scholar 

  30. Virta L (1991) Lumbar spondylolytic spondylolisthesis in adults. Prevalence in Finland and associations with back pain and functional capacity. Thesis. University of Turku, Finland

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Acknowlegments

This study was funded by the Foundation for Pediatric Research, The Finnish Orthopaedic and Traumatologic Foundation, The Scientific Foundation of Rinnekoti and The Finnish Medical Society Duodecim.

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Authors and Affiliations

  1. ORTON Orthopaedic Hospital, Invalid Foundation, Tenholantie 10, 00280, Helsinki, Finland

    Tuomas Jalanko, Timo Yrjönen, Mikko Poussa & Dietrich Schlenzka

  2. Turku Children’s Hospital, Turku University Central Hospital, Kiinamyllynkatu 4-8, 20521, Turku, Finland

    Ilkka Helenius

  3. Peijas Hospital, Helsinki University Central Hospital, P.O. Box 900, 00029 HUS, Helsinki, Finland

    Ville Remes

  4. Department of Orthopaedics and Traumatology, Helsinki University Central Hospital, Topeliuksenkatu 5, P.O. Box 266, 00029 HUS, Helsinki, Finland

    Tommi Lamberg

  5. HUS-Röntgen, Helsinki University Central Hospital, Tukholmankatu 2, P.O. Box 750, 00029 HUS, Helsinki, Finland

    Pekka Tervahartiala

  6. Runeberginkatu 25 A 2, 00100, Helsinki, Finland

    Tuomas Jalanko

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  1. Tuomas Jalanko
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  2. Ilkka Helenius
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  3. Ville Remes
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  6. Timo Yrjönen
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  7. Mikko Poussa
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  8. Dietrich Schlenzka
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Correspondence to Tuomas Jalanko.

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Jalanko, T., Helenius, I., Remes, V. et al. Operative treatment of isthmic spondylolisthesis in children: a long-term, retrospective comparative study with matched cohorts. Eur Spine J 20, 766–775 (2011). https://doi.org/10.1007/s00586-010-1591-7

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  • DOI: https://doi.org/10.1007/s00586-010-1591-7

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