Introduction Nonoperative treatment is the first prerogative for patients with degenerative spondylolisthesis without neurological deficit. In cases where persistent pain or neurological deficit becomes prevalent, surgery becomes an option. In this cross-sectional study, we evaluated clinical and functional results of patients with lumbar degenerative spondylolisthesis treated nonoperatively or surgically. Patients and Methods Patients with degenerative spondylolisthesis treated either nonoperatively or surgically from 2004 to 2014 were selected from databases and a cross-sectional evaluation was applied. Outcome measures included back and leg visual analog scales (VAS), Fischgrund criteria, short form-36 (SF-36) physical function, and the modified oswestry disability index (ODI). Results Of the 85 patients who met the inclusion criteria, we evaluated 43 in total: 20 with nonoperative treatment and 23 with surgical treatment. Baseline characteristics were similar without significant differences. The mean follow-up time was 43 months (range, 10–72 months) for nonsurgically and 36 months (range, 6–80 months) for surgically treated groups. The surgical group displayed better scores in back VAS (8 vs. 4), leg VAS (6 vs. 3), SF-36 physical function (35 vs. 77), and ODI (46 vs. 17). On the basis of the Fischgrund criteria, only 10% of patients reported excellent or good health post nonoperative treatment versus 83% for those treated surgically. Conclusion Symptomatic patients with lumbar degenerative spondylolisthesis treated surgically obtained better clinical and functional scores than patients treated nonoperatively. The limitations of the study do not permit statistical analysis and hence further review is necessary to draw firm conclusions.
Introduction Many etiologies can lead to atlantoaxial subluxation. In Grisel syndrome, this subluxation occurs spontaneously after inflammatory processes of the head and neck. Nonsurgical treatment most often resolves the symptoms; however, in some cases, surgical treatment is necessary to repair the subluxation. Various surgical techniques and instrumentation systems have been used to treat atlantoaxial subluxation, although there is no consensus regarding the best treatment method for the pediatric population. We aim to describe a modified surgical technique for the treatment of atlantoaxial subluxation in a child with Grisel syndrome. Patient and Methods: Our case study involves a 5-year-old female patient with a 6-month history of unresolved Fielding type II atlantoaxial subluxation because of the Grisel syndrome. Despite conservative treatment, the patient's symptoms continued to progress. After two failed closed reduction attempts, open reduction and C1–C2 fusion with a modified Goel–Harms technique was performed with atlas laminar hook and axis pedicle polyaxial screws. A literature review of the surgical treatment of the Grisel syndrome was also performed. Results After surgery, the patient exhibited full clinical and functional recoveries with complete resolution of symptoms. At the 24-month follow-up examination, there was continual evidence of satisfactory reduction and fusion. No complications were observed. On completion of the literature review, seven Grisel syndrome cases were found to have been treated surgically with the minimum patient age being 9 years. Conclusion Conservative management of Grisel syndrome is the most common and effective treatment; however, a few surgical cases have been reported in the literature with good results. We exhibit a safe, new surgical construct for pediatric patients in the treatment of atlantoaxial subluxation and instability, with satisfactory clinical results and solid fusion at 24 months postsurgery.
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