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Finnish Orthopedic Association: Mariehamn, May 11-12, 1990

1990; Taylor & Francis; Volume: 61; Issue: sup239 Linguagem: Inglês

10.3109/17453679009153768

0001-6470

Seppo Seitsalo,

Spine and Intervertebral Disc Pathology

The progression of the spondylolisthesis is rare after cessation of the growth. The risk of progression has widely been accepted as an indication of operative fusion in children and adolescents. We stiU do not know why some slippings do not progress and other slippings displace even until a total spondyloptosis presents. Aim: The aims of the study were 1) to analyze how much and how frequently progression of the spondylolisthesis occurs after the first radiographic examination in children and adolescents, 2) to determine possible c l i c a l or radiographic prognostic factors for the further progression, and 3) to analyze what effect the fusion in situ has on the progression. Patients: Radiographic progression of slipping in spondylolisthesis in children and adolescents treated under the age of 20 years either operatively or conservatively was studied. Posterior or posterolateral fusion in situ was performed in 190 patients, and 82 patients were treated conservatively. There were 134 girls and 138 boys. The mean age at admission was 14 years, and the follow-up mean time was 15 (5-32) years. The fifth lumbar segment was affected in 265 and the fourth segment in 7 patients. The degree of the slipping was measured as a percentage of the width of the olisthetic vertebral body. The average slipping in the fust radiograph was 38 (5-138) percent. Results: Progression of the slipping during the followup was on an average 3.5 percent (from -30 to 98 percent). Ninety percent of the final slipping on an average had already occurred at the time of first radiographic examination. Progression of more than 10 percent was seen in 62 patients. Spontaneous correction of the slipping more than 10 percent was seen in 17 patients. The modality of treatment (conservative or operative) had statistically no effect on progression. Although dysplasia (spina bifida) at the lumbosacral junction and female gender were associated with more severe slippings, they statistically had no prognostic value for the further progression. In the regression analysis, lumbar lordosis, rounding of the sacral endplate, or lumbar index (wedge form of the olisthetic vertebra) represented no prognostic value. They were secondary to the slipping: they express it, but they do not predict it. The only radiographic variable having predictive value on the risk of further progression was the degree of primary slipping. The risk of further slipping was significant if the initial slipping was 20 percent or more. In age groups that corresponded to the phase of prepubertal growth spurt (girls 9-12 years, boys 11-14 years), there was a tendency to undergo progression, which was more significant than in other age groups.