For posterior spinal decompression surgery to aggravate Spondylolysis or Spondylolisthesis, signs/symptoms of Spondylolysis or Spondylolisthesis should occur within 10 years of the surgery.
BACKGROUND: Management of degenerative spondylolisthesis with spinal stenosis is controversial. Surgery is widely used, but its effectiveness in comparison with that of nonsurgical treatment has not been demonstrated in controlled trials. METHODS: Surgical candidates from 13 centers in 11 U.S. states who had at least 12 weeks of symptoms and image-confirmed degenerative spondylolisthesis were offered enrollment in a randomized cohort or an observational cohort. Treatment was standard decompressive laminectomy (with or without fusion) or usual nonsurgical care. The primary outcome measures were the Medical Outcomes Study 36-Item Short-Form General Health Survey (SF-36) bodily pain and physical function scores (100-point scales, with higher scores indicating less severe symptoms) and the modified Oswestry Disability Index (100-point scale, with lower scores indicating less severe symptoms) at 6 weeks, 3 months, 6 months, 1 year, and 2 years. RESULTS: We enrolled 304 patients in the randomized cohort and 303 in the observational cohort. The baseline characteristics of the two cohorts were similar. The one-year crossover rates were high in the randomized cohort (approximately 40% in each direction) but moderate in the observational cohort (17% crossover to surgery and 3% crossover to nonsurgical care). The intention-to-treat analysis for the randomized cohort showed no statistically significant effects for the primary outcomes. The as-treated analysis for both cohorts combined showed a significant advantage for surgery at 3 months that increased at 1 year and diminished only slightly at 2 years. The treatment effects at 2 years were 18.1 for bodily pain (95% confidence interval [CI], 14.5 to 21.7), 18.3 for physical function (95% CI, 14.6 to 21.9), and ?16.7 for the Oswestry Disability Index (95% CI, ?19.5 to ?13.9). There was little evidence of harm from either treatment. CONCLUSIONS: In nonrandomized as-treated comparisons with careful control for potentially confounding baseline factors, patients with degenerative spondylolisthesis and spinal stenosis treated surgically showed substantially greater improvement in pain and function during a period of 2 years than patients treated nonsurgically.
Nonsurgical Treatment for Lumbar Degenerative Spondylolisthesis
Ikuta K, Tono O and Oga M: Clinicaloutcome of microendoscopic posterior decompression for spinalstenosis associated with degenerative spondylolisthesis - minimum2-year outcome of 37 patients. Minim Invas Neurosurg. 51:267–271.2008.
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Therefore, we aimed to investigate the effect of axial loading on the morphology of the spine and the spinal canal in patients with degenerative spondylolisthesis of L4–5 and to correlate morphologic changes to their disability and physical functions.
Denied benefits for degenerative disc disease or other back problems
Sasai K, Umeda M, Maruyama T, WakabayashiE and Iida H: Microsurgical bilateral decompression via aunilateral approach for lumbar spinal canal stenosis includingdegenerative spondylolisthesis. J Neurosurg Spine. 9:554–559. 2008. :
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Axially loaded MRI using the Dynawell device, allows to demonstrate morphological changes in patients with symptomatic degenerative spondylolisthesis. Only SA at L4–5 is well correlated with physical disability (ODI) and PF; the post-load LLA was well correlated to the PF of patients with degenerative L4–L5 spondylolisthesis. Under axially loaded MRI, SA of L4–5 can be a good indicator of disability in patients with degenerative spondylolisthesis of L4–5.