Surgical Treatment of Spondylolytic Spondylolisthesis

Spondylolysis is generally accepted as an acquired pseudoarthrosis after a fatique fracture in patients who has a hereditary predisposition, while the slippage can occur at the age of adolescent. Operation was unnecessary for most patients because they were symptom free. The indication of surgery in our hospital included persistent back pain unresponsive to conservative treatment, nerve root compression with the result of spinal stenosis. Seventy-one patients operated from May 1984 to June 1990 were reviewed. The age ranged from 18 to 67 years, averaged 43 years of age. Pars defects were located at L4 in 22 cases, at L5 in 46 cases, 2at both L4 and L5, one at both L3 and L4. There were 23 spondylolysis patients, 43 grade one and 5 grade two spondylolisthesis patients. The operation techniques were posterolateral fusion with cancellous bone graft. The rate of fusion was 94.4% and was better at L5 lesion than L4 lesion group. All the patients under 35 years old got solid fusion no matter what operative techniques were used. Eleven of the 65 patients with solid fusion and the 6 nonunion patients were rated clinically unsatisfactory. The tendency of good union was noted in the patients with younger age and pars defect at L5 level. This may indicate that low grade spondylolisthesis over lumbosacral region was relatively more stable for the purpose of posterolateral fusion. Because the consecutive introduction of those four different implants to our hospital, this review showed that the semirigid 4 mm Zielke rods can provide a better chance for bony fusion in the old age group patients.

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