Nonsurgically managed patients with degenerative spondylolisthesis: a 10- to 18-year follow-up study

Abstract

<jats:p content-type="fine-print"><jats:italic>Object.</jats:italic> Controversy exists concerning the indications for surgery and choice of surgical procedure for patients with degenerative spondylolisthesis. The goals of this study were to determine the clinical course of nonsurgically managed patients with degenerative spondylolisthesis as well as the indications for surgery.</jats:p> <jats:p content-type="fine-print"><jats:italic>Methods.</jats:italic> A total of 145 nonsurgically managed patients with degenerative spondylolisthesis were examined annually for a minimum of 10 years follow-up evaluation. Radiographic changes, changes in clinical symptoms, and functional prognosis were surveyed.</jats:p> <jats:p content-type="fine-print">Progressive spondylolisthesis was observed in 49 patients (34%). There was no correlation between changes in clinical symptoms and progression of spondylolisthesis. The intervertebral spaces of the slipped segments were decreased significantly in size during follow-up examination in patients in whom no progression was found. Low-back pain improved following a decrease in the total intervertebral space size. A total of 84 (76%) of 110 patients who had no neurological deficits at initial examination remained without neurological deficit after 10 years of follow up. Twenty-nine (83%) of the 35 patients who had neurological symptoms, such as intermittent claudication or vesicorectal disorder, at initial examination and refused surgery experienced neurological deterioration. The final prognosis for these patients was very poor.</jats:p> <jats:p content-type="fine-print"><jats:italic>Conclusions.</jats:italic> Low-back pain was improved by restabilization. Conservative treatment is useful for patients who have low-back pain with or without pain in the lower extremities. Surgical intervention is indicated for patients with neurological symptoms including intermittent claudication or vesicorectal disorder, provided that a good functional outcome can be achieved.</jats:p>

Diagnosis and conservative management of degenerative lumbar spondylolisthesis

“…Only 10-15% of patients seeking treatment eventually will have surgery [45]. In a long term follow-up study of 145 nonsurgically managed patients [38] with DS progression of vertebral slippage was observed in 34% of patients. There was no correlation between changes in clinical symptoms and progression of spondylolisthesis.…”

“…The study of the natural history [38] showed that back pain improved as the disc space was collapsed and progression of the slippage occurred only in 34% of the cases. Seventy-six percent of the patients who were initially neurologically intact did not deteriorate over time and these patients may be treated conservatively.…”

“…Seventy-six percent of the patients who were initially neurologically intact did not deteriorate over time and these patients may be treated conservatively. Conversely, most patients (83%) with history of neurogenic claudication or vesicorectal symptoms deteriorated with poor final outcome and these patients should preferably have surgical treatment [38]. Recent study of Weinstein et al [61] found that patients with DS and spinal stenosis treated surgically showed substantially greater improvement in pain and function during a period of 2 years than patients treated nonsurgically.…”

Determinants of outcome in lumbar spinal stenosis surgery

“…With a follow-up of 10 years they found that DS progressed in 34% of the cases but there was no correlation between progression of the slip and clinical symptoms (Matsunaga et al 2000). In addition, no further progression of the slip was observed in the segments with collapsed discs and the back pain improved over time as the discs collapsed (Matsunaga et al 2000).…”

“…The natural course of untreated DS has been studied by Matsunaga et al (2000). With a follow-up of 10 years they found that DS progressed in 34% of the cases but there was no correlation between progression of the slip and clinical symptoms (Matsunaga et al 2000).…”