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Spine (Phila Pa 1976). 2000 Jul 1;25(13):1711-5.

Surgery versus conservative management in adult isthmic spondylolisthesis--a prospective randomized study: part 1.

Author information

1
Department of Orthopaedic Surgery, Karolinska Institutet, Huddinge University Hospital, Stockholm, Sweden.

Abstract

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.

PMID:
10870148
[Indexed for MEDLINE]

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