Decompression alone versus decompression and instrumented fusion for the treatment of isthmic spondylolisthesis: a randomized controlled trial

Journal of Neurosurgery Spine, vol. 35, pp. 687–697

Abstract

OBJECTIVE: The most advocated surgical technique to treat symptoms of isthmic spondylolisthesis is decompression with instrumented fusion. A less-invasive classical approach has also been reported, which consists of decompression only. In this study the authors compared the clinical outcomes of decompression only with those of decompression with instrumented fusion in patients with isthmic spondylolisthesis. METHODS: Eighty-four patients with lumbar radiculopathy or neurogenic claudication secondary to low-grade isthmic spondylolisthesis were randomly assigned to decompression only (n = 43) or decompression with instrumented fusion (n = 41). Primary outcome parameters were scores on the Roland Disability Questionnaire (RDQ), separate visual analog scales (VASs) for back pain and leg pain, and patient report of perceived recovery at 12-week and 2-year follow-ups. The proportion of reoperations was scored as a secondary outcome measure. Repeated measures ANOVA according to the intention-to-treat principle was performed. RESULTS: Decompression alone did not show superiority in terms of disability scores at 12-week follow-up (p = 0.32, 95% CI -4.02 to 1.34), nor in any other outcome measure. At 2-year follow-up, RDQ disability scores improved more in the fusion group (10.3, 95% CI 3.9-8.2, vs 6.0, 95% CI 8.2-12.4; p = 0.006, 95% CI -7.3 to -1.3). Likewise, back pain decreased more in the fusion group (difference: -18.3 mm, CI -32.1 to -4.4, p = 0.01) on a 100-mm VAS scale, and a higher proportion of patients perceived recovery as showing "good results" (44% vs 74%, p = 0.01). Cumulative probabilities for reoperation were 47% in the decompression and 13% in the fusion group (p < 0.001) at the 2-year follow-up. CONCLUSIONS: In patients with isthmic spondylolisthesis, decompression with instrumented fusion resulted in comparable short-term results, significantly better long-term outcomes, and fewer reoperations than decompression alone. Decompression with instrumented fusion is a superior surgical technique that should in general be offered as a first treatment option for isthmic spondylolisthesis, but not for degenerative spondylolisthesis, which has a different etiology.

Authors 9

1. Kayoumars Azizpour
   Affiliation as printed

   Departments of Neurosurgery and

   Departments of1Neurosurgery and

2. Pieter J. Schutte Aachen

   Alrijne Ziekenhuis

   Affiliation as printed

   Alrijne Hospital, Leiden and Leiderdorp, and

   Departments of Neurosurgery and

   Alrijne Hospital, Leiden and Leiderdorp, and; Departments of Neurosurgery and

3. Mark P. Arts

   Medisch Centrum Haaglanden · Stichting Haaglanden Medisch Centrum

   Affiliation as printed

   Department of Neurosurgery, Haaglanden Medical Center, The Hague;

   3Department of Neurosurgery, Haaglanden Medical Center, The Hague

4. Willem Pondaag Aachen

   Alrijne Ziekenhuis

   Affiliation as printed

   Alrijne Hospital, Leiden and Leiderdorp, and

   Departments of Neurosurgery and

   Alrijne Hospital, Leiden and Leiderdorp, and; Departments of Neurosurgery and

5. Gerrit J. Bouma

   OLVG

   Affiliation as printed

   Department of Neurosurgery, OLVG, Amsterdam;

6. Maarten Hubert Coppes

   University Medical Center Groningen

   Affiliation as printed

   University Medical Center Groningen;

   5University Medical Center Groningen

7. Erik W. van Zwet Aachen Biostatistics 2Biostatistics

   Leiden University Medical Center

   Affiliation as printed

   Biostatistics, Leiden University Medical Center, Leiden;

   2Biostatistics, Leiden University Medical Center, Leiden;

8. Wilco C. Peul Aachen

   Medisch Centrum Haaglanden · Alrijne Ziekenhuis · Stichting Haaglanden Medisch Centrum

   Affiliation as printed

   Alrijne Hospital, Leiden and Leiderdorp, and

   Department of Neurosurgery, Haaglanden Medical Center, The Hague;

   Departments of Neurosurgery and

   Alrijne Hospital, Leiden and Leiderdorp, and; Department of Neurosurgery, Haaglanden Medical Center, The Hague;; Departments of Neurosurgery and

9. Carmen L. A. Vleggeert-Lankamp

   Medisch Centrum Haaglanden · Spaarne Ziekenhuis · Spaarne Gasthuis · Stichting Haaglanden Medisch Centrum

   Affiliation as printed

   Department of Neurosurgery, Haaglanden Medical Center, The Hague;

   Departments of Neurosurgery and

   Spaarne Gasthuis, Haarlem/Hoofddorp, The Netherlands

   Department of Neurosurgery, Haaglanden Medical Center, The Hague;; Departments of Neurosurgery and; Spaarne Gasthuis, Haarlem/Hoofddorp, The Netherlands