Review Question - QID 5445

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Degenerative Spondylolisthesis Treatment Operative QID: 5445 (OBQ14.35)

QID 5445 (Type "5445" in App Search)

Figures A through F are the radiographs and MR images of a 66-year-old woman with right buttock, thigh and leg pain that is worse with ambulation. Compared to patients treated non-operatively, patients with her pathology who are treated operatively can expect which of the following four years after surgery?

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Less pain relief but better function

48/3998

Less pain relief and worse function

47/3998

Greater pain relief and equivalent function

12%

482/3998

Greater pain relief and improved function

75%

2985/3998

Equivalent pain relief and improved function

372/3998

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This patient has degenerative spondylolisthesis and spinal stenosis. The Spine Patient Outcomes Research Trial (SPORT) showed that operatively treated patients had greater pain relief and function at four years.

Neurogenic claudication, presenting with bilateral buttock pain that is worse with standing and improves with sitting, is a classic finding of spinal stenosis. Spinal stenosis is frequently caused by degenerative spondylolithesis at L4-5 in adult patients. Due to the segmental instability associated with degenerative spondylolithesis, treatment is posterior laminectomy and arthrodesis. This is typically performed with a posterior lumbar interbody fusion (PLIF) or transforaminal lumbar interbody fusion (TLIF) and a pedicle screw construct.

Weinstein et al. evaluated a randomized cohort (from SPORT) of 304 patients and an observational cohort of 303 patients with degenerative spondylolisthesis and spinal stenosis. Although there was no difference in the intention-to-treat analysis, which was limited by non-adherence to treatment assignment, the as-treated analysis showed advantages of surgery for pain and function that persisted to four years.

Abdu et al., for the same group of patients, examined whether fusion technique affected outcome. They demonstrated that, at four years, there was no difference in pain and function among patients treated with any of three fusion techniques: (1) posterolateral in situ fusion, (2) posterolateral fusion with pedicle screw fixation, (3) posterolateral fusion with pedicle screw fixation and interbody fusion.

Figures A through E show a grade 1 spondylolisthesis with movement on flexion extension films. The MRI in Figure F shows spinal stenosis associated with disc herniation as well as facet and ligamentum flavum hypertrophy.

Incorrect Answers:
Answer 1: Surgically treated patients had better pain relief compared to non-operatively treated patients
Answer 2: Surgically treated patients had better pain relief and improved function compared to non-operatively treated patients
Answer 3: Surgically treated patients had improved function compared to non-operatively treated patients
Answer 5: Surgically treated patients had better pain relief compared to non-operatively treated patients