A continuous series of 27 adult patients treated for L5-S1 isthmic spondylolisthesis by combined approach: Clinical and radiological outcomes at 1 year follow-up

Abstract

Through this single-center consecutive prospective study, we evaluated the results of a combinedapproach for L5-S1 isthmic spondylolisthesis, using a polyetheretherketone (PEEK) interbody lordoticcage during anterior approach and pedicle screw-based posterior fixation. Between 2010 and 2014,27 adult patients were treated for L5-S1 isthmic spondylolisthesis (high and low grades) by a combi-ned approach with a minimum follow-up of one year. Clinical outcome was assessed before surgicaltreatment and at four months and one year after surgery by: VAS, Oswestry Index (ODI) and Rolland-Morris scores. Two observers evaluated the following radiological parameters: pelvic incidence, pelvictilt, lumbar lordosis, segmental lordosis L5-S1, anterior and posterior disc height, spinal vertical axis(SVA), SVA/sacro-femoral distance (SFD) ratio. Fusion was evaluated on the CT scan at one-year follow-up. Blood loss, surgery time and complications were also collected. The mean age was 47.7 years (± 16.9).The VAS, ODI and Rolland-Morris scores were significantly improved postoperatively, decreased from 7.5(± 1.45); 48 (± 19.25); 15.3 (± 4.67) before the surgery to 3.8 (± 2.55); 28.7 (± 19.58) and 7.76 (± 7.21)respectively at one year after the surgery (P = 0.05). The mean follow-up was 3.3 years. Mean surgery timewas 193.7 min (± 37). Fusion was obtained in 100% of cases. Segmental lordosis L5-S1, pelvic tilt, slip-page, anterior and posterior L5-S1 disc height were significantly improved postoperatively, they passedfrom 20.1; 22.6; 35.3%; 26.4%; 17.9% to 29.5; 20.6; 20.3%; 64.4%; 36.3% respectively. Combined surgicalprocedure meets the required goals of surgery in the treatment of adults L5-S1 isthmic spondylolisthesis.