Surgical Treatment of Degenerative Lumbar Spondylolisthesis

Eligibility

Inclusion Criteria:
  • Patients with radiographic evidence of focal (1 or 2 level) degenerative lumbar spondylolisthesis (DLS) and symptoms of neurogenic claudication or radicular pain with our without back pain.
  • Ability to understand the purpose of the study and willingness to participate.
  • Medical fitness for surgical management of DLS.
  • DLS unresponsive to at least 6 months of standard non-operative management.

Exclusion Criteria:

  • Presence of any tumors, isthmic spondylolisthesis or spinal fractures
  • Surgery requiring more than 2 level fusion.
  • Previous lumbar spine surgery other than a remote discectomy or laminectomy.
  • Concomitant cervical or thoracic myelopathy.
  • Presence of another degenerative condition, such as hip or knee osteoarthritis, which will significantly affect function.

Contact

  • Dr. Cynthia E. Dunning,   Cynthia.DunningZwicker@nshealth.ca

PI
Dr R Andrew Glennie

Description
Degenerative lumbar spondylolisthesis is a spinal condition that causes significant compression of spinal nerve roots, leading to pain and discomfort when a person tries to walk or stand. The natural history of the condition is that symptoms worsen and eventually a lack of mobility will have a profound effect on a
person’s quality of life. Decompression of the affected nerve roots can improve symptoms dramatically.

Traditionally, before the advent of modern spinal instrumentation, patients would undergo a decompression
procedure, which involved removing the bone and ligament covering the nerve roots. The procedure alleviated leg symptoms, but a small proportion of patients would report a degree of post-operative back pain and occasionally a recurrence of symptoms in their legs due to scarring and ongoing instability at the operative level. In the early 1990’s, modern pedicle screw instrumentation allowed surgeons to perform decompressions and fuse the spine, essentially eliminating the problem of post-operative instability. Many
of the reports at the time demonstrated superior results of fusion surgery; however, this also lead to greater problems at the spinal level above and high rates of long term re-operation.

Over the past 25 years, very few studies have compared simple decompression against decompression and fusion. Further, very few studies have focused on how to classify the varying degrees of instability that can exist in individual patients. Determining those patients that require only decompression versus those that require decompression and fusion, could potentially lead to better patient outcomes. To this end, the
degenerative spondylolithesis instability classification (DSIC) scheme has recently been developed.  The overall purpose of this prospective cohort study is to determine whether DLS patients treated according to the DSIC have similar or potentially better outcomes than those patients who universally undergo traditional spinal fusion based upon patient reported outcomes (i.e., health questionnaires).

 

Sample size= 130