Instrumented and noninstrumented posterolateral fusion in adult spondylolisthesis - A prospective randomized study: Part 2

Study Design. A prospective randomized study was performed. Objective. To determine whether transpedicular fixation improves the outcom e of posterolateral fusion in patients with adult isthmic spondylolisthesis . Summary of Background Data. The use of transpedicular fixation remains cont roversial. Both a positive effect and no effect from additional transpedicu lar fixation have been reported. Methods. In this study, 77 patients randomly underwent posterolateral fusio n with (n = 37) or without (n = 40) transpedicular fixation. The inclusion criteria were lumbar isthmic spondylolisthesis of any grade, at least 1 yea r of low back pain or sciatica, and severely restricted functional ability in individuals 18 to 55 years of age. Results. The follow-up rate was 94%. At a 2-year follow-up assessment, the level of pain and functional disability were strikingly similar in the two groups, and there was no significant difference in fusion rate. Conclusions. Lumbar posterolateral fusion performed in situ for adult isthm ic spondylolisthesis relieves pain and improves function. The use of supple mentary transpedicular instrumentation does not add to the fusion rate or i mprove the clinical outcome.