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Quality of life of patients with high-grade spondylolisthesis: minimum 2-year follow-up after surgical and nonsurgical treatments

  • Étienne Bourassa-Moreau
    Affiliations
    Faculty of Medicine, University of Montreal, 2900 Boulevard Edouard-Montpetit Montreal, QC H3T 1J4, Canada

    Hôpital du Scaré-Coeur de Montreal, Montreal, QC, Canada
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  • Jean-Marc Mac-Thiong
    Correspondence
    Corresponding author. Department of Surgery, CHU Sainte-Justine, 3175 Côte-Sainte-Catherine, Montréal, Québec H3T 1C5, Canada. Tel.: (514) 345-4876; fax: (514) 345-4755.
    Affiliations
    Faculty of Medicine, University of Montreal, 2900 Boulevard Edouard-Montpetit Montreal, QC H3T 1J4, Canada

    Hôpital du Scaré-Coeur de Montreal, Montreal, QC, Canada

    CHU Ste-Justine, 3175, Chemin de la Côte-Sainte-Catherine, Montreal H3T 1C5, Quebec, Canada
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  • Julie Joncas
    Affiliations
    CHU Ste-Justine, 3175, Chemin de la Côte-Sainte-Catherine, Montreal H3T 1C5, Quebec, Canada
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  • Stefan Parent
    Affiliations
    Faculty of Medicine, University of Montreal, 2900 Boulevard Edouard-Montpetit Montreal, QC H3T 1J4, Canada

    Hôpital du Scaré-Coeur de Montreal, Montreal, QC, Canada

    CHU Ste-Justine, 3175, Chemin de la Côte-Sainte-Catherine, Montreal H3T 1C5, Quebec, Canada
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  • Hubert Labelle
    Affiliations
    Faculty of Medicine, University of Montreal, 2900 Boulevard Edouard-Montpetit Montreal, QC H3T 1J4, Canada

    CHU Ste-Justine, 3175, Chemin de la Côte-Sainte-Catherine, Montreal H3T 1C5, Quebec, Canada
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      Abstract

      Background context

      Surgical intervention is generally indicated in a pediatric high-grade spondylolisthesis to prevent the progression of deformity or neurologic deterioration and improve the quality of life. However, the outcome of the treatment on the health-related quality of life (HRQOL) of patients with high-grade spondylolisthesis remains largely unknown.

      Purpose

      To describe the changes in the HRQOL of patients with pediatric high-grade spondylolisthesis after surgical and nonsurgical managements.

      Study design

      Observational case series with a minimal of 2-year follow-up.

      Patient sample

      Twenty-eight pediatric patients with high-grade spondylolisthesis from a single institution filled the inclusion criteria. Twenty-three patients were managed surgically and five were managed nonsurgically.

      Outcome measures

      Self-report measures: Scoliosis Research Society questionnaires (SRS-22). Neurologic examination, radiographic evaluation of slip grade.

      Methods

      The SRS-22 questionnaire was collected at the baseline (initial presentation for the nonsurgical group and preoperative visit for the surgical group) and at the last follow-up. Differences between baseline and last follow-up were evaluated in both groups. Correlation between the baseline score of SRS-22 score and improvement in the SRS-22 score was determined in surgical patients.

      Results

      In surgical patients, total SRS-22 scores were 3.31±0.50 at the baseline and 4.26±0.50 at the last follow-up. In nonsurgical patients, total SRS-22 scores were 4.12±0.16 at the baseline and 4.14±0.38 at the last follow-up. Therefore, variation in the SRS-22 total score was +0.94±0.77 (p<.001) for surgical patients and +0.02 ± 0.35 (p=.854) for nonsurgical patients. Improvement of the SRS-22 score was correlated with a low baseline value of SRS-22 (R²=0.61; p<.001). There was no neurologic or slip deterioration during the follow-up for patients treated nonsurgically.

      Conclusions

      The HRQOL improves after a surgical intervention for high-grade spondylolisthesis. Patients with lower baseline HRQOL scores are those who benefit the most from surgery. Close observation is a safe and feasible option in selected patients with a good baseline HRQOL and no neurologic impairment.

      Keywords

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