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High-grade spondylolisthesis in young patients: Long-term results of in situ fusion
Örebro University, School of Medical Sciences.ORCID iD: 0000-0002-7931-9617
2020 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The purpose of this long-term follow-up of 38 of 40 consecutive patients was to evaluate the results of uninstrumented in situ fusion for high-grade isthmic spondylolisthesis three decades after surgery. The mean age at surgery was 14 (range 9-24) years. The first of four studies evaluated clinical outcome, function, work status, and health-related quality of life (HRQoL) after in situ fusion in relation to age-matched Swedish population data. The second study evaluated effects on sagittal balance after in situ fusion. The third study evaluated adjacent segment disk degeneration after in situ fusion. The fourth study evaluated self-imageand HRQoL after in situ fusion in relation to healthy controls.

The main findings were that (1) young patients fused in situ for highgrade isthmic spondylolisthesis have long-term HRQoL similar to the general Swedish population and controls matched for age and gender, (2) signs of non-compensated sagittal imbalance were observed only ina few individuals whereas compensated sagittal balance was the norm, (3) there was no correlation between any radiographic sagittal balance parameter and HRQoL outcome, (4) there was only a minor reduction inadjacent segment disk height which had no impact on HRQoL outcome, and (5) the only patient reported outcome measure indicating a detrimental effect at long-term follow-up was self-assessed trunk appearance which was slightly negatively affected.

Place, publisher, year, edition, pages
Örebro: Örebro University , 2020. , p. 63
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 205
Keywords [en]
Adjacent segment disk degeneration, Fusion in situ, Health-related quality of life, Sagittal balance, Self-image, Spondylolisthesis
National Category
Surgery
Identifiers
URN: urn:nbn:se:oru:diva-78541ISBN: 978-91-7529-291-5 (print)OAI: oai:DiVA.org:oru-78541DiVA, id: diva2:1376918
Public defence
2020-02-14, Örebro universitet, Campus USÖ, hörsal C3, Södra Grev Rosengatan 32, Örebro, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2019-12-10 Created: 2019-12-10 Last updated: 2020-02-21Bibliographically approved
List of papers
1. Normal Health-Related Quality of Life and Ability to Work Twenty-nine Years After in Situ Arthrodesis for High-Grade Isthmic Spondylolisthesis
Open this publication in new window or tab >>Normal Health-Related Quality of Life and Ability to Work Twenty-nine Years After in Situ Arthrodesis for High-Grade Isthmic Spondylolisthesis
2014 (English)In: Journal of Bone and Joint Surgery. American volume, ISSN 0021-9355, E-ISSN 1535-1386, Vol. 96, no 12, article id e100Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The purpose of this mixed prospective and retrospective case series was to evaluate the long-term health-related quality of life and physical disability after in situ arthrodesis for high-grade isthmic spondylolisthesis.

METHODS: Thirty-five of forty consecutive patients who had in situ spinal arthrodesis for high-grade isthmic spondylolisthesis at a mean age of fifteen years (range, nine to twenty-five years) completed validated questionnaires (Short Form-36 [SF-36], EuroQol-5 Dimensions [EQ-5D], Zung depression scale, Oswestry disability index [ODI], Million score, and back and leg pain visual analog scale [VAS]) and underwent physical examination twenty-nine years (range, twenty-three to thirty-five years) after surgery. The mean age at the time of follow-up was forty-three years (range, thirty-seven to fifty-one years). In the absence of a formal control group, the scores on the SF-36 and EQ-5D were compared with Swedish normative data. The proportion of patients at work was compared with an age-matched control group derived from official statistics of Sweden. The Million score at the long-term follow-up was compared with the corresponding results at the mid-term follow-up of the same patients at a mean age of twenty-two years.

RESULTS: The scores on the SF-36 and EQ-5D were similar to the scores of the general Swedish population. The mean Zung depression scale score was 30 (range, 20 to 52), the mean ODI score was 10 (range, 0 to 34), the mean back pain VAS score was 13 (range, 0 to 72), and the mean leg pain VAS score was 9 (range, 0 to 60). The Million score averaged 28 (range, 0 to 109) and was slightly worsened compared with the score of 19 (range, 0 to 94) at the mid-term follow-up (p = 0.034). The proportion of patients at work was the same as that for the age-matched general Swedish population.

CONCLUSIONS: Our study shows good outcomes in health-related quality of life, disability, pain, and ability to work at up to twenty-nine years after in situ lumbar spine arthrodesis for high-grade isthmic spondylolisthesis.

LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Place, publisher, year, edition, pages
Stanford University Press, 2014
National Category
Orthopaedics
Identifiers
urn:nbn:se:oru:diva-71914 (URN)10.2106/JBJS.M.00064 (DOI)000343798400003 ()24951743 (PubMedID)2-s2.0-84903448099 (Scopus ID)
Available from: 2019-01-29 Created: 2019-01-29 Last updated: 2020-01-15Bibliographically approved
2. Sagittal Balance and Health-Related Quality of Life Three Decades After in Situ Arthrodesis for High-Grade Isthmic Spondylolisthesis
Open this publication in new window or tab >>Sagittal Balance and Health-Related Quality of Life Three Decades After in Situ Arthrodesis for High-Grade Isthmic Spondylolisthesis
Show others...
2018 (English)In: Journal of Bone and Joint Surgery. American volume, ISSN 0021-9355, E-ISSN 1535-1386, Vol. 100, no 16, p. 1357-1365Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: This case series of consecutive patients evaluated sagittal balance and health-related quality of life (HRQoL) 3 decades after in situ arthrodesis for high-grade isthmic spondylolisthesis.

METHODS: Global sagittal balance, pelvic parameters, and compensatory mechanisms were evaluated on standing lateral radiographs of the spine and pelvis for 28 of 39 consecutive patients, 28 to 41 years after in situ arthrodesis for high-grade L5 to S1 spondylolisthesis. The mean age at surgery was 14 years (range, 9 to 24 years), and the mean age at the time of follow-up was 48 years (range, 39 to 59 years). A subset of the radiographic parameters was compared with the corresponding data from an 8-year follow-up examination of the same patients. HRQoL was evaluated with the Scoliosis Research Society (SRS)-22r questionnaire.

RESULTS: We found that 3 of the 28 patients had a global sagittal imbalance (T1 spinopelvic inclination of >0°). Signs of compensatory mechanisms, such as reduced thoracic kyphosis and pelvic retroversion, were frequent. There was a significant decrease in sacral slope compared with 8-year follow-up data (p = 0.01). The median SRS-22r subscore was on the same level as Swedish normative data. We found no association between radiographic parameters and SRS-22r outcome.

CONCLUSIONS: Three decades after in situ arthrodesis for high-grade spondylolisthesis, radiographic signs of noncompensated sagittal imbalance were observed in only a few individuals. The patients had normal SRS-22r scores. There was no association between any radiographic parameter and SRS-22r outcome. The findings are relevant in the controversial discussion on whether to perform a reduction procedure to treat high-grade spondylolisthesis.

LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Place, publisher, year, edition, pages
Stanford University Press, 2018
National Category
Orthopaedics Surgery
Identifiers
urn:nbn:se:oru:diva-68504 (URN)10.2106/JBJS.17.01415 (DOI)000441556200006 ()30106816 (PubMedID)2-s2.0-85056496721 (Scopus ID)
Available from: 2018-08-17 Created: 2018-08-17 Last updated: 2020-01-15Bibliographically approved
3. Adjacent segment disk degeneration three decades after fusion without attempted reduction for high-grade isthmic spondylolisthesis
Open this publication in new window or tab >>Adjacent segment disk degeneration three decades after fusion without attempted reduction for high-grade isthmic spondylolisthesis
Show others...
2020 (English)In: Spine deformity, ISSN 2212-134XArticle in journal (Refereed) Epub ahead of print
Abstract [en]

STUDY DESIGN: Observational study.

OBJECTIVES: To evaluate adjacent segment disk degeneration (ASD) after fusion without attempted reduction at a young age for high-grade isthmic spondylolisthesis. The clinical relevance of ASD remains unclear. Previous studies have shown that spinal fusion is associated with increased ASD but without influence on clinical outcome. Since high-grade spondylolisthesis is a severe kyphotic deformity, one could hypothesize that fusion without attempted reduction in young patients leads to accelerated adjacent segment disk degeneration in adult life.

METHODS: Anterior and posterior disk heights were evaluated on supine radiographs of the spine 8 years and 29 years after fusion without attempted reduction for high-grade spondylolisthesis and also on standing radiographs 8 years and 33 years after surgery. Pelvic parameters were evaluated on standing radiographs obtained 33 years after surgery. Health-related quality of life was evaluated with the Scoliosis Research Society (SRS)-22r questionnaire.

RESULTS: One segment above fusion the anterior disk height significantly decreased on standing radiographs. Two segments above the fusion, the anterior disk height significantly decreased on supine as well as on standing radiographs. The largest reduction was found two segments above the fusion where the disk height was reduced from 33 to 28% of anterior vertebral height between the measurements at mean 8 years and mean 33 years after surgery. There were no statistically significant decreases in posterior disk heights in any measurement. The disk height showed a moderate negative correlation to PT. There was no correlation between disk height reduction and SRS-22r outcome.

CONCLUSIONS: In our long-term follow-up of fusion without attempted reduction for high-grade spondylolisthesis in young patients, we found only a minor but statistically significant reduction in adjacent segment disk height which had no apparent impact on clinical outcome.

LEVEL OF EVIDENCE: Level IV.

Place, publisher, year, edition, pages
Springer, 2020
Keywords
Adjacent segment disk degeneration, Disk height, Fusion without attempted reduction, SRS-22, Spondylolisthesis
National Category
Orthopaedics
Identifiers
urn:nbn:se:oru:diva-80118 (URN)10.1007/s43390-020-00085-6 (DOI)32065380 (PubMedID)
Available from: 2020-02-21 Created: 2020-02-21 Last updated: 2020-02-21Bibliographically approved
4. Self-Image and Health-Related Quality of Life Three Decades After Fusion In Situ for High-Grade Isthmic Spondylolisthesis
Open this publication in new window or tab >>Self-Image and Health-Related Quality of Life Three Decades After Fusion In Situ for High-Grade Isthmic Spondylolisthesis
Show others...
2019 (English)In: Spine deformity, ISSN 2212-134X, Vol. 7, no 2, p. 293-297Article in journal (Refereed) Published
Abstract [en]

STUDY DESIGN: Observational study.

OBJECTIVES: To evaluate self-image after in situ fusion for high-grade isthmic spondylolisthesis.

SUMMARY OF BACKGROUND DATA: Certain clinical findings such as short trunk or waistline skin folds are often seen in high-grade spondylolisthesis. Since treatment with spinal fusion in situ does not address appearance, self-image and also health-related quality of life might be negatively affected in the short-term as well as the long-term perspective. This observational study evaluated health-related quality of life outcome including self-image three decades after in situ fusion for high-grade isthmic spondylolisthesis in relation to healthy controls.

METHODS: Thirty-eight of 39 consecutive patients, fused in situ for high-grade isthmic spondylolisthesis at a young age, completed the Scoliosis Research Society (SRS)-22r questionnaire 28-41 years after surgery. The results were compared with the results of an age- and gender-matched control group.

RESULTS: We found that the SRS-22r self-image domain scores were statistically significantly lower in patients than in controls whereas the pain and mental health scores were similar in patients and controls. Also, the SRS-22r function domain scores were statistically significantly lower in patients but the difference in means was small. We found no correlation between severity of slip and SRS-22r outcome.

CONCLUSIONS: In situ fusion for high-grade isthmic spondylolisthesis is a safe treatment option in the long term from a function and pain perspective, but the results of our study suggest that self-image is negatively affected long into adult life.

LEVEL OF EVIDENCE: Level IV.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Fusion in situ, Health-related quality of life, SRS-22r, Self-image, Spondylolisthesis
National Category
Orthopaedics
Identifiers
urn:nbn:se:oru:diva-71913 (URN)10.1016/j.jspd.2018.08.012 (DOI)30660224 (PubMedID)2-s2.0-85054010418 (Scopus ID)
Available from: 2019-01-29 Created: 2019-01-29 Last updated: 2020-02-21Bibliographically approved

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