PDF herunterladen
J Neurol Surg A Cent Eur Neurosurg 2023; 84(04): 355-359
DOI: 10.1055/a-1747-9905
Original Article

The Fate of Nonoperative Management in Patients with Lytic Spondylolisthesis

Siddharth Sinha
1   Manchester Medical School, University of Manchester, Manchester, United Kingdom
,
K. Joshi George
1   Manchester Medical School, University of Manchester, Manchester, United Kingdom
2   Department of Neurosurgery, Salford Royal NHS Foundation Trust, Salford, United Kingdom
› Institutsangaben Funding None.
› Weitere Informationen
Auch verfügbar auf
    Lizenzen und Reprints

Abstract

Background There is a lack of consensus within the current literature about the role of nonoperative management in lytic spondylolisthesis. Our objective was to assess the fate that nonoperative management plays in patients diagnosed with lytic spondylolisthesis.

Methods Data were collected between May 2015 and February 2020 from 41 patients who were initially referred specifically for instrumented lumbar fixation but were instead planned for nonoperative management as they opted to avoid surgery. Magnetic resonance imaging (MRI) scans were used to determine spondylolisthesis grade, type of deformity, and radiologic features. Patient notes were reviewed to establish management plans. Furthermore, patients were also contacted via telephone to assess their symptoms and disease progression.

Results Twenty-six of the 41 patients had lytic spondylolisthesis (63.4%). Of these patients, the male-to-female ratio was 10:16. The median age was 60 (range: 22–76) years. A total of 12 patients were managed nonoperatively for 5 years or longer, with 2 patients showing progression from grade I to II.

Conclusion Nonoperative management of lytic spondylolisthesis is a reasonable option in a selected cohort of patients. The longer in duration patients are managed conservatively, the less likely they are to require a surgical intervention. Even severe radiologic foraminal stenosis without radicular pain does not seem to push patients toward surgery. Management decisions must be made on an individual basis. These data can give some reassurance to patients who wish to consider nonoperative management and help guide clinicians.

Keywords

spondylolisthesis - Meyerding classification - Oswestry disability index - nonoperative management

Ethical ApprovalLevels at which the abnormality is present for both degenerative and lytic patient

This article does not contain any studies with human participants performed by any of the authors.




Publikationsverlauf

Eingereicht: 09. August 2021

Angenommen: 19. Januar 2022

Accepted Manuscript online:
21. Januar 2022

Artikel online veröffentlicht:
27. Juni 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Gagnet P, Kern K, Andrews K, Elgafy H, Ebraheim N. Spondylolysis and spondylolisthesis: a review of the literature. J Orthop 2018; 15 (02) 404-407
    CrossrefPubMedGoogle Scholar
  • 2 Kalichman L, Kim DH, Li L, Guermazi A, Berkin V, Hunter DJ. Spondylolysis and spondylolisthesis: prevalence and association with low back pain in the adult community-based population. Spine 2009; 34 (02) 199-205
    CrossrefPubMedGoogle Scholar
  • 3 Meyerding H. Low backache and sciatic pain associated with spondylolisthesis and protruded intervertebral disc: incidence, significance, and treatment. J Bone Jt Surg 1941; 23 (02) 461-470
    PubMedGoogle Scholar
  • 4 Wang YXJ, Káplár Z, Deng M, Leung JCS. Lumbar degenerative spondylolisthesis epidemiology: a systematic review with a focus on gender-specific and age-specific prevalence. J Orthop Translat 2016; 11: 39-52
    CrossrefPubMedGoogle Scholar
  • 5 Ferrari S, Vanti C, O'Reilly C. Clinical presentation and physiotherapy treatment of 4 patients with low back pain and isthmic spondylolisthesis. J Chiropr Med 2012; 11 (02) 94-103
    CrossrefPubMedGoogle Scholar
  • 6 Evans N, McCarthy M. Management of symptomatic degenerative low-grade lumbar spondylolisthesis. EFORT Open Rev 2018; 3 (12) 620-631
    CrossrefPubMedGoogle Scholar
  • 7 Kalichman L, Hunter DJ. Diagnosis and conservative management of degenerative lumbar spondylolisthesis. Eur Spine J 2008; 17 (03) 327-335
    CrossrefPubMedGoogle Scholar
  • 8 Eismont FJ, Norton RP, Hirsch BP. Surgical management of lumbar degenerative spondylolisthesis. J Am Acad Orthop Surg 2014; 22 (04) 203-213
    CrossrefPubMedGoogle Scholar
  • 9 Garet M, Reiman MP, Mathers J, Sylvain J. Nonoperative treatment in lumbar spondylolysis and spondylolisthesis: a systematic review. Sports Health 2013; 5 (03) 225-232
    CrossrefPubMedGoogle Scholar
  • 10 van Hooff ML, Spruit M, Fairbank JCT, van Limbeek J, Jacobs WCH. The Oswestry Disability Index (version 2.1a): validation of a Dutch language version. Spine 2015; 40 (02) E83-E90
    CrossrefPubMedGoogle Scholar
  • 11 Möller H, Hedlund R. Surgery versus conservative management in adult isthmic spondylolisthesis: a prospective randomized study: part 1. Spine 2000; 25 (13) 1711-1715
    CrossrefPubMedGoogle Scholar
  • 12 Freedman MK, Hilibrand AS, Blood EA. et al. The impact of diabetes on the outcomes of surgical and nonsurgical treatment of patients in the spine patient outcomes research trial. Spine 2011; 36 (04) 290-307
    CrossrefPubMedGoogle Scholar