Document Detail


Surgery versus conservative management in adult isthmic spondylolisthesis--a prospective randomized study: part 1.
MedLine Citation:
PMID:  10870148     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
STUDY DESIGN: A prospective randomized study was performed. OBJECTIVE: To determine whether posterolateral fusion in patients with adult isthmic spondylolisthesis results in an improved outcome compared with an exercise program. SUMMARY OF BACKGROUND DATA: In spondylolisthesis, satisfactory results have been reported with both surgical and conservative management. The evidence for treatment efficacy, however, is weak because prospective randomized studies are lacking. METHODS: In this study, 111 patients were randomly allocated to an exercise program (n = 34) or posterolateral fusion with or without transpedicular fixation (n = 77). The inclusion criteria were lumbar isthmic spondylolisthesis of any grade, at least 1 year of low back pain or sciatica, and a severely restricted functional ability in individuals 18 to 55 years of age. Pain and functional disability were quantified before treatment and at 1- and 2-year follow-up assessments by visual analog scales (VAS). RESULTS: The 2-year follow-up rate was 93%. The functional outcome, as assessed by the Disability Rating Index and the pain reduction, was better in the surgically treated group than in the exercise group at both the 1- and 2-year follow-up assessments (P < 0.01). In the longitudinal analysis, the mean Disability Rating Index and pain improved in the surgical group (P < 0.0001). In the exercise group, the Disability Rating Index did not change at all, whereas the pain decreased slightly (P < 0.02). CONCLUSIONS: Surgical management of adult isthmic spondylolisthesis improves function and relieves pain more efficiently than an exercise program.
Authors:
H Möller; R Hedlund
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Spine     Volume:  25     ISSN:  0362-2436     ISO Abbreviation:  Spine     Publication Date:  2000 Jul 
Date Detail:
Created Date:  2000-08-24     Completed Date:  2000-08-24     Revised Date:  2009-07-09    
Medline Journal Info:
Nlm Unique ID:  7610646     Medline TA:  Spine (Phila Pa 1976)     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1711-5     Citation Subset:  IM    
Affiliation:
Department of Orthopaedic Surgery, Karolinska Institutet, Huddinge University Hospital, Stockholm, Sweden.
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MeSH Terms
Descriptor/Qualifier:
Adult
Exercise Therapy*
Female
Follow-Up Studies
Humans
Longitudinal Studies
Low Back Pain / surgery,  therapy
Lumbar Vertebrae / surgery
Male
Postoperative Complications
Prospective Studies
Recovery of Function
Spinal Fusion*
Spondylolisthesis / rehabilitation,  surgery*,  therapy*
Treatment Outcome
Comments/Corrections
Comment In:
Spine (Phila Pa 1976). 2001 Mar 1;26(5):594-5   [PMID:  11242393 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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