Instrumented and Noninstrumented Posterolateral Fusion in Adult Spondylolisthesis

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Abstract
A prospective randomized study was performed. To determine whether transpedicular fixation improves the outcome of posterolateral fusion in patients with adult isthmic spondylolisthesis. The use of transpedicular fixation remains controversial. Both a positive effect and no effect from additional transpedicular fixation have been reported. In this study, 77 patients randomly underwent posterolateral fusion with (n = 37) or without (n = 40) transpedicular fixation. The inclusion criteria were lumbar isthmic spondylolisthesis of any grade, at least 1 year of low back pain or sciatica, and severely restricted functional ability in individuals 18 to 55 years of age. The follow-up rate was 94%. At a 2-year follow-up assessment, the level of pain and functional disability were strikingly similar in the two groups, and there was no significant difference in fusion rate. Lumbar posterolateral fusion performed in situ for adult isthmic spondylolisthesis relieves pain and improves function. The use of supplementary transpedicular instrumentation does not add to the fusion rate or improve the clinical outcome.