Spondylolisthesis is a medical term used to describe a vertebral body that slips forward on the one below. The problem is associated with hyperextension of the spine, as often happens in sports like gymnastics and football. This extreme backward bend in the spine focuses stress on a section of the bony ring around the spinal column. In some cases, this can cause the bony ring to fracture, allowing the vertebra to slip forward on the one below.
People with spondylolisthesis may find relief from a combination of treatments like medication and physical therapy. However, if the pain continues, nerve problems start. If the vertebra has slipped too far, surgery might be needed.
Various surgical procedures have been used over the years to help people with spondylolisthesis. History is a wonderful teacher, especially when it comes to finding out which surgical procedures seem to work the best. Unfortunately, there isn’t a lot of information that shows how people are faring many years after surgery for spondylolisthesis. The researchers for this study went back through history to see the long-term benefits of two different types of surgery.
This follow-up study reviewed 22 patients who had lumbar surgery for spondylolisthesis between 1968 and 1999. Ten patients had fusion surgery. Twelve patients underwent fusion with metal hardware, known as Harrington instrumentation. On average the patients were 17.9 years old when they had the surgery. As part of the follow-up, the authors had each patient examined an average of 15 years after the surgery. Participants also filled out two separate surveys about their back health. The authors also gave the surveys to a group of people who never had back pain. This allowed researchers to compare the surgery patients and the general population.
Most of the surgical patients showed similar results on the surveys. Their results were even comparable to people who had never experienced back pain. However, this was not true when surgical patients were known to have had a large amount of slippage before surgery. The authors believe these results support the use of surgery in patients with spondylolisthesis.
In the past, some surgeons reasoned that attaching hardware onto the bones of the spine would hold the spine in better alignment, make the fusion more solid, and keep the spine from slipping in the future. They expected people with Harrington implants to fare better over the years. Not so in this case. At the follow-up, complications were much higher among those with the implants.
The authors acknowledge that newer types of hardware are being used with improved success these days. However, their results lead them to conclude that fusion alone gives similar long-term benefits without risking the complications of Harrington implants.