Outcome after surgery for isthmic spondylolisthesis and degenerative disc disease

Individuals with isthmic spondylolisthesis and lumbar degenerative disc disease may have low back and leg pain. Those with persistent symptoms non-responsive to conservative treatment are sometimes treated surgically. Various surgical methods have been introduced, but long-term outcome comparisons are scarce. The Swedish Spine register (Swespine) was used to study long term outcome after fusion surgery for isthmic spondylolisthesis and lumbar degenerative disc disease. In addition, we determined the effect of loss to follow-up on patient reported outcome interpretation, as well as the diagnostic accuracy of surgical information in Swespine. Another cohort was used to determine the long-term risk of radiologically verified adjacent segment degeneration after interbody fusion and posterolateral fusion.

We found that the Swedish Spine register gives fairly reliable information about the surgical event. Loss to follow-up is of minor importance in the outcome interpretation after lumbar spine surgery. At long term, patient reported outcome was similar when comparing interbody fusion and posterolateral fusion in isthmic spondylolisthesis and degenerative disc disease. The long-term risk of radiologically verified adjacent segment degeneration was similar after interbody fusion and posterolateral fusion. The risk of additional lumbar spine surgery for any reason was significantly higher in those individuals that had undergone interbody fusion compared to those that had undergone posterolateral fusion. Even though patient reported outcome was improved after surgery for isthmic spondylolisthesis, the quality of life did not reach the levels of the normative population.

List of scientific papers

I. Minor effect of loss to follow-up on outcome interpretation in the Swedish Spine Register. Peter Endler, Per Ekman, Frida Hellström, Hans Möller, Paul Gerdhem. [Manuscript]

II. Outcomes of Posterolateral Fusion with and without Instrumentation and of Interbody Fusion for Isthmic Spondylolisthesis. Peter Endler, Per Ekman, Hans Möller, Paul Gerdhem. J Bone Joint Surg Am. 2017;99:743-52.
https://doi.org/10.2106/JBJS.16.00679

III. Long term Outcome after Spinal Fusion for Isthmic Spondylolisthesis in Adults. Peter Endler, Per Ekman, Hanna Ljungqvist, Torkel Brismar, Paul Gerdhem, Hans Möller. The Spine J. 2018 Aug 22.
https://doi.org/10.1016/j.spinee.2018.08.008

IV. Long term Outcome of Fusion for Degenerative Disc Disease in the Lumbar Spine. Peter Endler, Per Ekman. Ivan Berglund, Hans Möller, Paul Gerdhem. [Manuscript]