Reduction Versus non-reduction technique in low grade spondylolisthesis ; functional outcome

ABSTRACT

Spondylolisthesis is a condition in which a vertebra slips anteriorly in relation to the vertebra below as a results of pars defect or degenerative disease.The slipped segment produces abnormal positioning of the vertebrae in relation to each other along the spinal column that causing back pain and neurologic deficit.There are debates about surgical maneuvers low grade spondylolisthesis [grade 1 and 2 according to meyerding classification] whether to reduce the slipped segment or not, the aim of this study is to determine the short and long term difference in the functional iutcome between these methods. This randomized prospective study consist of 32 patients aged between 42-63 years old [11 males and 21 females] treated for sypmtomatic low grade spondylolisthesis between october 2009 to november 2011 and followed up for 24 months.All patients were randomly divided into two groups group 1 [15 patients] underwent surgical reduction of the slipped segment, and group 2 [17 patients] who underwent in-situ fusion without reduction.both groups had the same pre and postoperative managment.Early postoperative minor complications uncluding one case in each group had superficial wound infections [6.6% and 5.8% in group 1 and 2 respectively] had dural tear intraoperatively that was repaired during the operation; none of patients has CSF leak postoperatively there were two cases in group 1 [13.3%] and one in group 2 [5.8%] had postoperative transient sciatic pain due to nerve irritaton.Depending on the Oswestry disability index [ODI] there was a significant statistical difference between both groups in the shirt term [p-value=0.004] but there was no significant statstical difference in the long term follow up between them [p-value=0.33] regarding the functional outcome.Surgical treatment of low grade symptomatic spondylolisthesis usualy include neural decompression fixation and fusion; however reduction of the slipped segment is not necessary for these patients as the ultimate outcome is similar to those who underwent in-situ fusion only