Prognosis and operative treatments for patients with adolescent scoliosis associated with lumbar spondylolisthesis

English Keywords:Adolescent scoliosis  Idiopathic  Lumbar spondylolisthesis  Prognosis  Surgical strategy

English Abstract:

  【Abstract】 Objectives: To investigate the prognosis and operative treatments for patients with adolescent scoliosis associated with lumbar spondylolisthesis. Methods: A total of 9 adolescent scoliosis associated with lumbar spondylolisthesis cases from May 2002 to January 2011 was included in this study. The average age of 9 patients was 14.4±2.7 ys(range, 10-18 ys). Long-cassette standing posterior-anterior and lateral radiographs of the spine at pre-operation, post-operation and last follow-up were obtained from these patients in the fist-on-clavicle position. The 9 patients included 3 functional and 6 idiopathic scoliosis, 3 developmental and 6 isthmic spondylolisthesis. All patients received different surgical procedures and were numbered as 1-9. All of their listhesis levels were L5/S1. According to Meyerding system, there were 4 cases at grade Ⅰ, 2 at grade Ⅱ, 2 at grade Ⅲ, 1 at grade Ⅳ. 3 patients with functional scoliosis received only slippage reduction and posterior lumbar interbody fusion. 2 patients without low back pain were treated with only scoliosis correction. And the other 3 symptomatic patients received surgical reduction combined with correction of scoliosis. Measurement parameters were as followings: Cobb angle, slip angle, slip distance and slip percentage. The patient′s low back pain was assessed by Oswestry disability index(ODI). Results: The average rate of improvement of Cobb angle on different surgical procedures was 41.4%(11.5%-58.1%), 75.2%(68.6%-81.8%) and 78.2%(72.9%-86.2%) respectively, meanwhile the slip percentage was 56.3%(27.3%-76.9%), 48.4%(25.0%-71.8%) and 49.8%(31.8%-67.7%) respectively. 7 patients presented with low back pain. The ODI scores declined from 26.0（21.0-31.0） and 23.0（15.0-29.0） to 7.0（5.0-10.0） and 6.0（5.0-8.0） after different interventions. No postoperative complications were found in our series. Conclusions: The severe scoliosis should be considered idiopathic and should be treated differently apart from spondylolisthesis when spondylolisthesis is asymptomatic. If spondylolisthesis is symptomatic, scoliosis should be treated together with spondylolisthesis according to the curve magnitude.