The Spine Journal
Volume 10, Issue 6 , Pages 530-543 , June 2010

Contemporary management of isthmic spondylolisthesis: pediatric and adult

  • Steven S. Agabegi, MD

      Affiliations

    • Department of Orthopaedic Surgery, University of Cincinnati, PO Box 670212, Cincinnati, OH 45267, USA
    • Corresponding Author InformationCorresponding author. Department of Orthopaedic Surgery, University of Cincinnati, PO Box 670212, Cincinnati, OH 45267, USA. Tel.: (610) 717-8597.
  • ,
  • Jeffrey S. Fischgrund, MD

      Affiliations

    • Ste. 200-B, 27207 Lahser Rd, Southfield, MI 48034-2168, USA

Received 2 February 2010 ,Accepted 18 February 2010.

References 

  1. Meyerding HW. Spondylolisthesis. Surg Gynecol Obstet. 1932;54:371–377
  2. Fredrickson BE, Baker D, McHolick WJ, et al. The natural history of spondylolysis and spondylolisthesis. J Bone Joint Surg Am. 1984;66:699–707
  3. Beutler WJ, Fredrickson BE, Murtland A, et al. The natural history of spondylolysis and spondylolisthesis: 45-year follow-up evaluation. Spine. 2003;28:1027–1035
  4. Danielson BI, Frennered AK, Irstam LKH. Radiologic progression of isthmic lumbar spondylolisthesis in young patients. Spine. 1991;16:422–425
  5. Saraste H. Long-term clinical, radiological follow-up of spondylolysis and spondylolisthesis. J Pediatr Orthop. 1987;7:631–638
  6. McPhee IB, O'Brien JP, McCall IW, et al. Progression of lumbosacral spondylolisthesis. Aust Radiol. 1981;25:91–95
  7. Osterman K, Schlenzka D, Poussa M, et al. Isthmic spondylolisthesis in symptomatic and asymptomatic subjects, epidemiology and natural history with special reference to disk abnormality and mode of treatment. Clin Orthop. 1993;297:65–70
  8. Frennered AK, Danielson BI, Nachemson AL. Natural history of symptomatic isthmic low-grade spondylolisthesis in children and adolescents: a seven-year follow-up study. J Pediatr Orthop. 1991;11:209–213
  9. Pizzutillo PD, Hummer CH. Nonoperative treatment for painful adolescent spondylolysis or spondylolisthesis. J Pedriatr Orthop. 1989;9:538–540
  10. Bell DF, Ehrlich MG, Zaleske DJ. Brace treatment for symptomatic spondylolisthesis. Clin Orthop. 1988;236:192–198
  11. Moller H, Hedlund R. Surgery versus conservative management in adult isthmic spondylolisthesis: a prospective randomized study: part 1. Spine. 2000;25:1711–1715
  12. Steiner ME, Micheli LJ. Treatment of symptomatic spondylolysis and spondylolisthesis with modified Boston brace. Spine. 1985;10:937–943
  13. Suh PB, Esses SI, Kostuik JP. Repair of pars interarticularis defect. The prognostic value of pars infiltration. Spine. 1991;16(8 Suppl):S445–S448
  14. Buck JE. Direct repair of the defect in spondylolisthesis: preliminary report. J Bone Joint Surg Br. 1970;52:432–437
  15. Buck JE, Pederson AK, Hagen R. Spondylolysis and spondylolisthesis: treatment by internal fixation and bone grafting of the defect. J Bone Joint Surg Am. 1988;70:15–24
  16. Nichol R, Scott J. Lytic spondylolisthesis. Repair by wiring. Spine. 1986;11:1027–1030
  17. Roca J, Moretta D, Fuster S, et al. Direct repair of spondylolysis. Clin Orthop. 1989;140:86–91
  18. Bradford DS, Iza J. Repair of the defect in spondylolysis or minimal degrees of spondylolisthesis by segmental wire fixation and bone grafting. Spine. 1985;10:673–679
  19. Deguchi M, Rapoff A, Zdeblick TA. Biomechanical comparison of spondylolysis fixation techniques. Spine. 1999;24:328–333
  20. Tokuhashi Y, Matsuzaki H. Repair of defects in spondylolysis by segmental pedicle screw hook fixation. Spine. 1996;21:2041–2045
  21. Gillet P, Petit M. Direct repair of spondylolysis without spondylolisthesis using a rod-screw construct and a bone grafting of the pars defect. Spine. 1999;24:1252–1256
  22. Kakiuchi M. Repair of the defect in spondylolysis. Durable fixation with pedicle screws and laminar hooks. J Bone Joint Surg Am. 1997;70:818–825
  23. Gill GG, Manning JG, White HL. Surgical treatment of spondylolisthesis without spine fusion: excision of the loose lamina with decompression of the nerve roots. J Bone Joint Surg Am. 1955;37:493–520
  24. Gill GG, White HL. Surgical treatment of spondylolisthesis without spine fusion: a long-term followup of operated cases. Acta Orthop Scan Suppl. 1965;85:5–99
  25. Gill GG. Long-term follow-up evaluation of a few patients with spondylolisthesis treated by excision of the loose lamina with decompression of the nerve roots without spinal fusion. Clin Orthop. 1984;182:215–219
  26. Osterman K, Lindholm TS, Laurent LE. Late results of removal of the loose posterior element (Gill's operation) in the treatment of lytic lumbar spondylolisthesis. Clin Orthop. 1976;117:121–128
  27. Marmor L, Bechtol CO. Spondylolisthesis: complete slip following the Gill procedure: a case report. J Bone Joint Surg Am. 1961;43:1068–1069
  28. Amuso SJ, Neff RS, Coulson DB, Laing PG. The surgical treatment of spondylolisthesis by posterior element resection: a long-term follow-up study. J Bone Joint Surg Am. 1970;52:529–536
  29. Tiusanen H, Schlenzka D, Seitsalo S, et al. Results of a trial of anterior or circumferential fusion in the treatment of severe isthmic spondylolisthesis in young patients. J Pediatr Orthop Br. 1996;5:190–194
  30. Friberg O. Instability in spondylolisthesis. Orthopedics. 1991;14:463–466
  31. Wiltse LL, Jackson DW. Treatment of spondylolisthesis and spondylolysis in children. Clin Orthop. 1976;117:92–100
  32. Monticelli G, Ascani E. Spondylolysis and spondylolisthesis. Acta Orthop Scand. 1975;46:498–506
  33. Sherman FC, Rosenthal RK, Hall JE. Spine fusion for spondylolysis and spondylolisthesis in children. Spine. 1979;4:59–67
  34. Hensinger R, Lang J, MacEwen G. Surgical management of spondylolisthesis in children and adolescents. Spine. 1976;1:207–216
  35. Pizzutillo PD, Mirenda W, MacEwen GD. Posterolateral fusion for spondylolisthesis in adolescence. J Pediatr Orthop. 1986;6:311–316
  36. Frennered AK, Danielson BI, Nachemson AL, et al. Midterm follow-up of young patients fused in situ for spondylolisthesis. Spine. 1991;16:409–416
  37. Hambly M, Lee CK, Gutteling E, et al. Tension band wiring-bone grafting for spondylolysis and spondylolisthesis: a clinical and biomechanical study. Spine. 1989;14:455–460
  38. Schnee CL, Freese A, Ansell LV. Outcome analysis for adults with spondylolisthesis treated with posterolateral fusion and transpedicular screw fixation. J Neurosurg. 1997;86:56–63
  39. Lenke LG, Bridwell KH, Bullis D, et al. Results of in situ fusion for isthmic spondylolisthesis. J Spinal Disord. 1992;5:433–442
  40. Vaccaro AR, Ring D, Scuderi G, et al. Predictors of outcome in patients with chronic back pain and low-grade spondylolisthesis. Spine. 1997;22:2030–2034
  41. de Loubresse CG, Bon T, Deburge A, et al. Posterolateral fusion for radicular pain in isthmic spondylolisthesis. Clin Orthop. 1996;323:194–201
  42. Carragee EJ. Single-level posterolateral arthrodesis, with or without posterior decompression, for the treatment of isthmic spondylolisthesis in adults. A prospective, randomized study. J Bone Joint Surg Am. 1997;79:1175–1180
  43. Haraldsson S, Willner S. A comparative study of spondylolisthesis in operation on adolescents and adults. Arch Orthop Trauma Surg. 1983;101:101–105
  44. Johnson LP, Nasca RJ, Dunham WK. Surgical management of isthmic spondylolisthesis. Spine. 1988;13:93–97
  45. Boxall D, Bradford DS, Winter RB, Moe JH. Management of severe spondylolisthesis in children and adolescents. J Bone Joint Surg Am. 1979;61:479–495
  46. Moller H, Hedlund R. Instrumented and noninstrumented posterolateral fusion in adult spondylolisthesis—a prospective randomized study: part 2. Spine. 2000;25:1716–1721
  47. France JC, Yaszemski MJ, Lauerman WC. A randomized prospective study of posterolateral lumbar fusion. Outcomes with and without pedicle screw instrumentation. Spine. 1999;24:553–560
  48. McGuire RA, Amundson GM. The use of primary internal fixation in spondylolisthesis. Spine. 1993;18:1662–1672
  49. Thomsen K, Christensen FB, Eiskjaer SP, et al. 1997 Volvo Award winner in clinical studies. The effect of pedicle screw instrumentation on functional outcome and fusion rates in posterolateral lumbar spinal fusion: a prospective, randomized clinical study. Spine. 1997;22:2813–2822
  50. Bridwell KH, Sedgewick TA, O'Brien MF, et al. The role of fusion and instrumentation in the treatment of degenerative spondylolisthesis with spinal stenosis. J Spinal Disord. 1993;6:461–472
  51. Deguchi M, Rapoff AJ, Zdeblick TA. Posterolateral fusion for isthmic spondylolisthesis in adults: analysis of fusion rate and clinical results. J Spinal Disord. 1998;11:459–464
  52. Ricciardi JE, Pflueger PC, Isaza JE, Whitecloud TS. Transpedicular fixation for the treatment of isthmic spondylolisthesis in adults. Spine. 1995;20:1917–1922
  53. Amundson GM, Wenger DR. Spondylolisthesis. Natural history and treatment. Spine. 1987;1:323–338
  54. Ishihara H, Osada R, Kanamori M, et al. Minimum 10-year follow-up study of anterior lumbar interbody fusion for isthmic spondylolisthesis. J Spinal Disord. 2001;14:91–99
  55. van Rens TJ, van Horn JR. Long-term results in lumbosacral interbody fusion for spondylolisthesis. Acta Orthop Scand. 1982;53:383–392
  56. Kim NH, Lee JW. Anterior interbody fusion versus posterolateral fusion with transpedicular fixation for isthmic spondylolisthesis in adults: a comparison of clinical results. Spine. 1999;24:812–816
  57. L'Heureux EA, Perra JH, Pinto MR, et al. Functional outcome analysis including preoperative and postoperative SF-36 for surgically treated adult isthmic spondylolisthesis. Spine. 2003;28:1269–1274
  58. La Rosa G, Conti A, Cacciola F, et al. Pedicle screw fixation for isthmic spondylolisthesis: does posterior lumbar interbody fusion improve outcome over posterolateral fusion?. J Neurosurg. 2003;99:143–150
  59. Barrick WT, Schofferman JA, Reynolds JB, et al. Anterior lumbar fusion improves discogenic pain at levels of prior posterolateral fusion. Spine. 2000;25:853–857
  60. Kwon BK, Hilibrand AS, Malloy K, et al. A critical analysis of the literature regarding surgical approach and outcome for adult low-grade isthmic spondylolisthesis. J Spinal Disord Tech. 2005;18 Suppl:S30–S40
  61. Suk SI, Lee CK, Kim WJ, et al. Adding posterior lumbar interbody fusion to pedicle screw fixation and posterolateral fusion after decompression in spondylolytic spondylolisthesis. Spine. 1997;22:210–219
  62. Madan S, Boeree NR. Outcome of posterior lumbar interbody fusion versus posterolateral fusion for spondylolytic spondylolisthesis. Spine. 2002;27:1536–1542
  63. Jacobs WC, Vreeling A, De Kleuver M. Fusion for low-grade adult isthmic spondylolisthesis: a systematic review of the literature. Eur Spine J. 2006;15:391–402
  64. Kwon BK, Albert TJ. Adult low-grade acquired spondylolytic spondylolisthesis: evaluation and management. Spine. 2005;30(6 Suppl):S35–S41
  65. Swan J, Hurwitz E, Malek F, et al. Surgical treatment for unstable low-grade isthmic spondylolisthesis in adults: a prospective controlled study of posterior instrumented fusion compared with combined anterior-posterior fusion. Spine J. 2006;6:606–614
  66. Ekman P, Möller H, Tullberg T, et al. Posterior lumbar interbody fusion versus posterolateral fusion in adult isthmic spondylolisthesis. Spine. 2007;32:2178–2183
  67. Kim KT, Lee SH, Lee YH, et al. Clinical outcomes of 3 fusion methods through the posterior approach in the lumbar spine. Spine. 2006;31:1351–1357
  68. Videbaek TS, Christensen FB, Soegaard R, et al. Circumferential fusion improves outcome in comparison with instrumented posterolateral fusion: long-term results of a randomized clinical trial. Spine. 2006;31:2875–2880
  69. Molinari RW, Lenke LG. Pediatric spondylolysis and spondylolisthesis. In:  Frymoyer JW,  Wiesel SW editor. The adult and pediatric spine. 3rd ed. Philadelphia, PA: Lippincott Williams and Wilkins; 2004;p. 399–423
  70. Harris IE, Weinstein SL. Long-term follow-up of patients with grade 3 and 4 spondylolisthesis: treatment with and without posterior fusion. J Bone Joint Surg Am. 1987;69:960–969
  71. Bartolozzi P, Sandri A, Cassini M, et al. One-stage posterior decompression-stabilization and trans-sacral interbody fusion after partial reduction for severe L5–S1 spondylolisthesis. Spine. 2003;28:1135–1141
  72. Peek RD, Wiltze LL, Reynolds JB, et al. In situ arthrodesis without decompression for Grade III and IV isthmic spondylolisthesis in adults who have severe sciatica. J Bone Joint Surg Am. 1989;71:62–68
  73. Smith M, Bohlman HH. Spondylolisthesis treated by a single-stage operation combining decompression with in situ posterolateral and anterior fusion: an analysis of 11 patients who had long-term follow-up. J Bone Joint Surg Am. 1990;72:415–421
  74. DeWald CJ, Vartabedian JE, Rodts MF, et al. Evaluation and management of high-grade spondylolisthesis in adults. Spine. 2005;30(6 Suppl):S49–S59
  75. Legaye J, Duval-Beaupere G, Hecquet J, et al. Pelvic incidence: a fundamental pelvic parameter for three-dimensional regulation of spinal sagittal curves. Eur Spine J. 1998;7:99–103
  76. Mac-Thiong JM, Berthonnaud E, Dimar JR, et al. Sagittal alignment of the spine and pelvis during growth. Spine. 2004;29:1642–1647
  77. Hresko MT, Labelle H, Roussouly P. Classification of high-grade spondylolistheses based on pelvic version and spine balance: possible rationale for reduction. Spine. 2007;32:2208–2213
  78. Labelle H, Roussouly P, Berthonnaud E, et al. The importance of spino-pelvic balance in L5–S1 developmental spondylolisthesis: a review of pertinent radiologic measurements. Spine. 2005;30(Suppl 6):27–34
  79. Descamps H, Commare-Nordmann MC, Marty C, et al. Modification of pelvic angle during the human growth. [in French] Biom Hum Anthropol. 1999;17:59–63
  80. Mangione P, Gomez D, Senegas J. Study of the course of the incidence angle during growth. Eur Spine J. 1997;6:163–167
  81. Huang RP, Bohlman HH, Thompson GH. Predictive value of pelvic incidence in progression of spondylolisthesis. Spine. 2003;28:2381–2385
  82. Hanson DS, Bridwell KH, Rhee JM, Lenke LG. Correlation of pelvic incidence with low- and high-grade isthmic spondylolisthesis. Spine. 2002;27:2026–2029
  83. Labelle H, Roussouly P, Berthonnaud E, et al. Spondylolisthesis, pelvic incidence, and spinopelvic balance: a correlation study. Spine. 2004;29:2049–2054
  84. Bradford DS. Treatment of severe spondylolisthesis: a combined approach for reduction and stabilization. Spine. 1979;4:423–429
  85. Transfeldt EE, Mehbod AA. Evidence-based medicine analysis of isthmic spondylolisthesis treatment including reduction versus fusion in situ for high-grade slips. Spine. 2007;32:S126–S129
  86. Seitsalo S. Operative and conservative treatment of moderate spondylolisthesis in young patients. J Bone Joint Surg Br. 1990;72:908–913
  87. Muschik M, Zippel H, Perka C. Surgical management of severe spondylolisthesis in children and adolescents. Anterior fusion in situ versus anterior spondylodesis with posterior transpedicular instrumentation and reduction. Spine. 1997;22:2036–2042
  88. Poussa M, Schlenzka D, Seitsalo S, et al. Surgical treatment of severe isthmic spondylolisthesis in adolescents. Reduction or fusion in situ. Spine. 1993;18:894–901
  89. Poussa M, Remes V, Lamberg T, et al. Treatment of severe spondylolisthesis in adolescence with reduction or fusion in situ: long-term clinical, radiologic, and functional outcome. Spine. 2006;31:583–590
  90. Shufflebarger HL, Geck MJ. High-grade isthmic dysplastic spondylolisthesis: monosegmental surgical treatment. Spine. 2005;30(6 Suppl):S42–S48
  91. Ruf M, Koch H, Melcher RP, Harms J. Anatomic reduction and monosegmental fusion in high-grade developmental spondylolisthesis. Spine. 2006;31:269–274
  92. Fabris DA, Costantini S, Nena U. Surgical treatment of severe L5-S1 spondylolisthesis in children and adolescents. Results of intraoperative reduction, posterior interbody fusion, and segmental pedicle fixation. Spine. 1996;21:728–733
  93. Smith JA, Deviren V, Berven S, et al. Clinical outcome of trans-sacral interbody fusion after partial reduction for high-grade L5-S1 spondylolisthesis. Spine. 2001;26:2227–2234
  94. Bradford DS, Boachie-Adjei O. Treatment of severe spondylolisthesis by anterior and posterior reduction and stabilization. A long-term follow-up study. J Bone Joint Surg Am. 1990;72:1060–1066
  95. Boachie-Adjei O, Do T, Rawlins BA. Partial lumbosacral kyphosis reduction, decompression, and posterior lumbosacral transfixation in high-grade isthmic spondylolisthesis: clinical and radiographic results in six patients. Spine. 2002;27:E161–E168
  96. Molinari RW, Bridwell KH, Lenke LG, et al. Complications in the surgical treatment of pediatric high-grade, isthmic dysplastic spondylolisthesis. A comparison of three surgical approaches. Spine. 1999;24:1701–1711
  97. Hu SS, Bradford DS, Transfeldt EE, Cohen M. Reduction of high-grade spondylolisthesis using Edwards instrumentation. Spine. 1996;21:367–371
  98. Bradford DS, Gotfried Y. Staged salvage reconstruction of grade IV and V spondylolisthesis. J Bone Joint Surg Am. 1987;69:191–202
  99. Boos N, Marchesi D, Zuber K, Aebi M. Treatment of severe spondylolisthesis by reduction and pedicular fixation: a 4-6 year follow-up study. Spine. 1993;12:1655–1661
  100. Maurice HD, Morley TR. Cauda equina lesions following fusion in situ and decompressive laminectomy for severe spondylolisthesis: four case reports. Spine. 1989;14:214–216
  101. Schoenecker PL, Cole HO, Herring JA, et al. Cauda equina syndrome after in situ arthrodesis for severe spondylolisthesis at the lumbosacral junction. J Bone Joint Surg Am. 1990;72:369–377
  102. Transfeldt EE, Dendrinos GK, Bradford DS. Paresis of proximal lumbar roots after reduction of L5-S1 spondylolisthesis. Spine. 1989;14:884–887
  103. Tiusanen H, Schlenzka D, Seitsalo S, et al. Results of a trial of anterior or circumferential lumbar fusion in the treatment of severe isthmic spondylolisthesis in young patients. J Pediatr Orthop B. 1996;5:190–194
  104. Laursen M, Thomsen K, Eiskjaer SP, et al. Functional outcome after partial reduction and 360 degree fusion in grade III-V spondylolisthesis in adolescent and adult patients. J Spinal Disord. 1999;12:300–306
  105. Petraco DM, Spivak JM, Cappadona JG, et al. An anatomic evaluation of L5 nerve stretch in spondylolisthesis reduction. Spine. 1996;21:1133–1138
  106. McPhee I, O'Brien J. Reduction of severe spondylolisthesis. A preliminary report. Spine. 1979;4:430–434
  107. Sijbrandij S. A new technique for the reduction and stabilization of severe spondylolisthesis: a report of two cases. J Bone Joint Surg Br. 1981;63B:266–271
  108. Bradford D. Controversies: instrumented reduction of spondylolisthesis. Spine. 1994;14:1536–1537
  109. Dubousset J. Treatment of spondylolysis and spondylolisthesis in children and adolescents. Clin Orthop Relat Res. 1997;337:77–85
  110. Ani N, Keppler L, Biscup RS, et al. Reduction of high-grade slips (grades III-V) with VSP instrumentation. Report of a series of 41 cases. Spine. 1991;16(6 Suppl):S302–S310
  111. DeWald RL, Faut MM, Taddonio RF, Neuwirth MG. Severe lumbosacral spondylolisthesis in adolescents and children. J Bone Joint Surg Am. 1981;63:619–626
  112. Bohlman HH, Cook SS. One-stage decompression and posterolateral and interbody fusion for lumbosacral spondyloptosis through a posterior approach. Report of two cases. J Bone Joint Surg Am. 1982;64:415–418
  113. Freeman BL, Donati NL. Spinal arthrodesis for severe spondylolisthesis in children and adolescents: a long-term follow-up study. J Bone Joint Surg Am. 1989;71:594–598
  114. Johnson JR, Kirwin EO. The long-term results of fusion in situ for severe spondylolisthesis. J Bone Joint Surg Br. 1983;65:43–46
  115. Seitsalo S, Osterman K, Hyvarinen J, et al. Severe spondylolisthesis in children and adolescents. A long-term review of fusion in situ. J Bone Joint Surg Br. 1990;72:259–265
  116. Stanton RP, Meehan P, Lovell WW. Surgical fusion in childhood spondylolisthesis. J Pediatr Orthop. 1985;5:411–415
  117. Grzegorzewski A, Kumar SJ. In situ posterolateral spine arthrodesis for grades III, IV, and V spondylolisthesis in children and adolescents. J Pediatr Orthop. 2000;20:506–511
  118. Burkus JK, Lonstein LE, Winter RB, Denis F. Long-term evaluation of adolescents treated operatively for spondylolisthesis: a comparison of in situ arthrodesis only with in situ arthrodesis and reduction followed by immobilization in a cast. J Bone Joint Surg Am. 1992;74:693–704
  119. Molinari RW, Bridwell KH, Lenke LG, et al. Anterior column support in surgery for high-grade, isthmic spondylolisthesis. Clin Orthop. 2002;394:109–120
  120. Roca J, Ubierna MT, Caceres E, Iborra M. One-stage decompression and posterolateral and interbody fusion for severe spondylolisthesis: an analysis of 14 patients. Spine. 1999;24:709–714
  121. Abdu WA, Wilber RG, Emery SE. Pedicular transversal screw fixation of the lumbosacral spine in spondylolisthesis: a new technique for stabilization. Spine. 1994;19:710–715
  122. Hanson DS, Bridwell KH, Rhee JM, Lenke LG. Dowel fibular strut grafts for high-grade dysplastic isthmic spondylolisthesis. Spine. 2002;27:1982–1988
  123. Gaines RW, Nichols WK. Treatment of spondyloptosis by two stage L5 vertebrectomy and reduction of L4 onto S1. Spine. 1985;10:680–686
  124. Lehmer SM, Steffee AD, Gaines RW. Treatment of spondyloptosis by two stage L5 vertebrectomy and reduction of L4 onto S1 (Gaines procedure). Spine. 1994;10:680–686

 This Contemporary Concepts in Spine Care review is part of a series of referenced reviews of contemporary issues in spine care produced by the North American Spine Society (NASS). Each review represents the current state of knowledge on a particular topic. Prior to entering the review process for The Spine Journal, the authors were assisted by members of the NASS Committee on Contemporary Concepts: Darrel Brodke, MD, Chair; Christopher Bono, MD; Robert Dawe, MD; and Mitchell B. Harris, MD.

 FDA device/drug status: not applicable.

 Author disclosures: JSF (royalties, DePuy; consulting, Stryker, releavant, Apatech, Smith and Nephew; research support, Smith and Nephew).

PII: S1529-9430(10)00128-2

doi: 10.1016/j.spinee.2010.02.023

The Spine Journal
Volume 10, Issue 6 , Pages 530-543 , June 2010