PREDICTORS OF OUTCOME IN PATIENTS WITH CHRONIC BACK PAIN AND LOW-GRADE SPONDYLOLISTHESIS

Study Design. Retrospective case series. Objectives. To determine the factors influencing symptom relief after uninstrumented posterolateral spinal fusion with or without decompression in adult patients with ch ronic back pain and previously asymptomatic low-grade isthmic spondylo listhesis. Summary of Background Data. The role of previously asymptom atic low-grade isthmic spondylolisthesis in chronic adult low back pai n is unclear. Operative intervention in this setting is controversial. Methods. Twenty-four consecutive adult patients with chronic low back pain and low-grade isthmic spondylolisthesis first detected during ro utine work-up of new onset low back pain underwent spinal fusion with or without decompression. The influence of active worker's compensatio n or litigation claims, radicular pain, concomitant laminectomy, age, gender, fusion to L4, intervertebral disc bulge, and pseudarthrosis we re investigated. Results, All 13 patients involved in worker's compens ation claims or pending litigation had fair or poor results. Nine of 1 1 patients without such issues had good or excellent results. Although the strong association of worker's compensation with poor results mad e it difficult to assess the importance of other risk factors, the dat a suggest that good results may be more likely in patients with radicu lopathy who undergo laminectomy. Conclusions. This investigation, alth ough limited by a number of factors including small sample size and re trospective, unblinded review, suggests that active worker's compensat ion and litigation issues are associated strongly with poor results of operative management for chronic low back pain in adult patients with low-grade spondylolisthesis.