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The Long Term Outcomes of Spinal Fusion in Adult Isthmic Spondylolisthesis
Keywords:
Lumbar, Patients, Spondylolisthesis, Fusion, Functional, Posterior.Abstract
Objective: To evaluate the long-term outcomes of spinal fusion surgery for different spinal disorders, such as isthmic spondylolisthesis.
Methods: The 67 patients, ages 18 to 55, who had adult lumbar isthmic spondylolisthesis and had experienced significant back pain for at least a year, either without or with sciatica. A one-year exercise regimen, posterolateral fusion having instrumentation or having no pedicle screw instrumentation were allotted to the patients at random. The 91 percent of patients had long-term follow-up.
Results: Longitudinal analysis: In both surgery groups, pain and functional impairment were considerably reduced at long-term follow-up compared to before treatment. In every analysed variable, there were no discernible differences between patients who had instruments and those who did not. Although the functional impairment was not improved at all in the exercise group, the discomfort did. Long-term functional impairment in the surgery group was significantly higher than it had been at the 2-year follow-up, as determined by DRI but not ODI. Between long-term and 2-year follow-up, no notable changes were seen in the exercise group. Analysis: In the follow-up of long-term there is no significant differences in between surgical and conservative groups which were seen in any outcome measurement, with the exception of the global assessment and they are significantly better for the patients of surgery. Compared to 50% of the patients receiving conservative care, 76% of patients of surgery rated all the outcomes as better or much better (p = 0.015). In all eight of the analysed areas, and found no differences in the long-term the life-quality measured by SF-36, but it was still much worse than for the general population.
Conclusions: When lumbar isthmic spondylolisthesis affects adults, posterior fusion yields a marginally better outcomes of long-term than exercise of a year. Patients having fusion still rate the overall outcomes as superior clearly to patients who received conservative treatment, despite the outcomes indicating that few of previously documented short-term gain are lost with time. Furthermore, one might draw the conclusion that not at all appreciable impulsive enhancement should be anticipated with time in the adult patients having the isthmic spondylolisthesis due to the long-term outcomes of patients who received conservative treatment most likely mirror the normal course. For the majority of patients, significant functional incapacity, pain, and lowered quality of the life are likely to persist for many years.
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