Surgery versus conservative management in adult isthmic spondylolisthesis - A prospective randomized study: Part 1

Study Design. A prospective randomized study was performed. Objective. To determine whether posterolateral fusion in patients with adul t 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 st udies are lacking. Methods. In this study, 111 patients were randomly allocated to an exercise program (n = 34) or posterolateral fusion with or without transpedicular f ixation (n = 77). The inclusion criteria were lumbar isthmic spondylolisthe sis of any grade, at least 1 year of low back pain or sciatica, and a sever ely restricted functional ability in individuals 18 to 55 years of age. Pai n 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 asse ssed by the Disability Rating Index and the pain reduction, was better in t he 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 m ean 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 improve s function and relieves pain more efficiently than an exercise program.