Surgery For Spondylolisthesis: What's Best?
When it comes to surgery to stabilize the spine for degenerative spondylolisthesis, what's the best operation? Just decompression (removal of bone)? Fusion with instrumentation (screws, metal plates)? Fusion without instrumentation?
Degenerative spondylolisthesis occurs when arthritis is combined with aging discs and degenerating spinal joints. Spondylolisthesis refers to the forward movement or displacement of the vertebra. The spine is unstable and neurologic problems can occur.
Slipping of the vertebra results in stretching and/or compression of the spinal cord and spinal nerves. The patient has back and/or pain, numbness,and weakness. Sometimes there are bowel and bladder problems. Surgery is the usual treatment for this problem.
In this report, researchers from the University of Ottawa (Canada) review studies on the topic from 1966 to 2005. They compared results of the three types of surgery to see if one had better results than the others.
They found 13 studies that qualified and could be included. There were a total of 578 patients with degenerative lumbar spondylolisthesis included. This type of review and analysis is called a systematic review. Instead of relying on the results of one study, the data can be pooled to show patterns of results more clearly.
The authors report a general trend of better results obtaining a solid fusion with an instrumented surgery. There was also a greater chance of repeat surgery with instrumented fusion. Both types of fusion surgeries had a lower reoperation rate compared with decompression.
Overall results were better with fusion surgery when compared with decompression alone. Achieving a solid fusion is more likely with instrumentation but the clinical outcomes (patient results) isn't better with one type of fusion over the other. More research is needed with better designed studies.
C. Ryan Martin, BSc, et al. The Surgical Management of Degenerative Lumbar Spondylolisthesis. In Spine. July 15, 2007. Vol. 32. No. 16. Pp. 1791-1798.