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Patient outcomes in the operative and nonoperative management of high-grade spondylolisthesis in children.

Publication ,  Journal Article
Lundine, KM; Lewis, SJ; Al-Aubaidi, Z; Alman, B; Howard, AW
Published in: J Pediatr Orthop
2014

BACKGROUND: The optimal management of high-grade spondylolisthesis in the growing child is controversial. Some authors have advocated for surgery in all cases regardless of symptoms. Surgical intervention results in a >10% risk of complications with increased risk of neurological injury associated with slip reduction maneuvers. There is a paucity of literature regarding nonoperative management in this setting. This study sought to obtain outcome measures in pediatric patients with high-grade spondylolisthesis managed either operatively or nonoperatively. METHODS: Database review was performed to identify patients with a high-grade (Meyerding grade III to V) spondylolisthesis managed either operatively or nonoperatively. Retrospective radiographic and chart review was performed. Patients were then contacted by phone to obtain current quality-of-life measurements using the Scoliosis Research Society (SRS)-30 questionnaire. RESULTS: Fifty-three patients were identified for inclusion in the study and 49 were contacted for 92% follow-up. Twenty-four patients were treated with operative intervention, and 25 patients were initially treated nonoperatively, but 10 went on to require surgical intervention. Mean age at presentation was 12.6 years (range, 8 to 17 y) and mean age at follow-up was 20.1 years (range, 10 to 29 y). There were no outcome differences between the groups. A more kyphotic slip angle was associated with worse SRS-30 outcome scores across all groups. In the nonoperative group, the slip angle was significantly larger in patients who failed conservative treatment (34 ± 17 degrees) than in those who remained nonsurgical at final follow-up (20 ± 14 degrees). Slip angle in the operative group was 27 ± 14 degrees. In surgical patients, an older age at surgery was associated with better SRS-30 outcome scores. CONCLUSIONS: Nonoperative management or "watchful waiting" of the minimally symptomatic or asymptomatic child with a high-grade spondylolisthesis is safe and does not lead to significant problems. Operative intervention for the symptomatic patient achieves similar long-term results compared with patients whose minimal symptoms do not warrant surgery. Delayed surgical intervention does not result in worse outcomes. Regardless of treatment modality, patients with a more kyphotic slip angle tend to have a poorer prognosis. LEVEL OF EVIDENCE: Level III.

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Published In

J Pediatr Orthop

DOI

EISSN

1539-2570

Publication Date

2014

Volume

34

Issue

5

Start / End Page

483 / 489

Location

United States

Related Subject Headings

  • Watchful Waiting
  • Treatment Outcome
  • Surveys and Questionnaires
  • Spondylolisthesis
  • Retrospective Studies
  • Radiography
  • Quality of Life
  • Orthopedics
  • Male
  • Humans
 

Citation

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ICMJE
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Lundine, K. M., Lewis, S. J., Al-Aubaidi, Z., Alman, B., & Howard, A. W. (2014). Patient outcomes in the operative and nonoperative management of high-grade spondylolisthesis in children. J Pediatr Orthop, 34(5), 483–489. https://doi.org/10.1097/BPO.0000000000000133
Lundine, Kristopher M., Stephen J. Lewis, Zaid Al-Aubaidi, Benjamin Alman, and Andrew W. Howard. “Patient outcomes in the operative and nonoperative management of high-grade spondylolisthesis in children.J Pediatr Orthop 34, no. 5 (2014): 483–89. https://doi.org/10.1097/BPO.0000000000000133.
Lundine KM, Lewis SJ, Al-Aubaidi Z, Alman B, Howard AW. Patient outcomes in the operative and nonoperative management of high-grade spondylolisthesis in children. J Pediatr Orthop. 2014;34(5):483–9.
Lundine, Kristopher M., et al. “Patient outcomes in the operative and nonoperative management of high-grade spondylolisthesis in children.J Pediatr Orthop, vol. 34, no. 5, 2014, pp. 483–89. Pubmed, doi:10.1097/BPO.0000000000000133.
Lundine KM, Lewis SJ, Al-Aubaidi Z, Alman B, Howard AW. Patient outcomes in the operative and nonoperative management of high-grade spondylolisthesis in children. J Pediatr Orthop. 2014;34(5):483–489.

Published In

J Pediatr Orthop

DOI

EISSN

1539-2570

Publication Date

2014

Volume

34

Issue

5

Start / End Page

483 / 489

Location

United States

Related Subject Headings

  • Watchful Waiting
  • Treatment Outcome
  • Surveys and Questionnaires
  • Spondylolisthesis
  • Retrospective Studies
  • Radiography
  • Quality of Life
  • Orthopedics
  • Male
  • Humans