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Factors Affecting Clinical Outcomes in Treating Patients With Grade 1 Degenerative Spondylolisthesis Using Interspinous Soft Stabilization With a Tension Band System: A Minimum 5-year Follow-up

Lee, Sang-Ho MD, PhD*; Lee, June-Ho MD*; Hong, Soon-Woo MD, PhD; Shim, Chan Shik MD, PhD*; Chung, Seung-Eun MD; Yoo, Seung-Hwa ME§; Lee, Ho-Yeon MD, PhD*

doi: 10.1097/BRS.0b013e31821c0b97
Clinical Case Series

Study Design. Retrospective clinical study.

Objective. To explore the factors influencing the clinical outcomes and motion-preserving stabilization after interspinous soft stabilization (ISS) with a tension band system for grade 1 degenerative spondylolisthesis (DS).

Summary of Background Data. Despite increasing recognition of the benefits of dynamic stabilization systems for treating lumbar degenerative disorders, the factors affecting the clinical and radiological outcomes of these systems have rarely been identified.

Methods. Sixty-five patients (mean age, 60.3 years) who underwent ISS with a tension band system between 2002 and 2004 were analyzed. The mean follow-up period was 72.5 months. The patients were divided according to the postsurgical clinical improvements into the optimal (n = 44) and suboptimal groups (n = 21), and the radiological intergroup differences were analyzed. Multiple linear regression analysis was performed to determine the impact of the radiological factors on the clinical outcomes.

Results. Significant intergroup differences were observed on the follow-up clinical examination. Radiologically, total lumbar lordosis (TLL) and segmental lumbar lordosis (SLL) were significantly improved only in the optimal group, resulting in significant intergroup differences in TLL (P = 0.023), SLL (P = 0.001), and the L1 tilt (P = 0.002). All these measures were closely associated with postoperative segmental lumbar lordosis, which also was the most influential radiological variable for the clinical parameters.

Conclusion. In the patients with grade 1 DS, the back pain relief and functional improvement following ISS were affected by the improvements in the sagittal spinal alignment through the achievement of segmental lumbar lordosis. ISS can be an alternative treatment to fusion surgery for grade 1 DS in patients who do not require fixation or reduction.

Several sagittal radiological parameters were analyzed following interspinous soft stabilization (ISS) with a tension band system for grade 1 degenerative spondylolisthesis by evaluating the variances between 2 patient groups showing optimal and suboptimal clinical results. The back pain relief and functional improvement following ISS were affected by the improvements in the sagittal alignment through the achievement of segmental lordosis.

*Departments of *Neurosurgery

Orthopedics

Radiology, Wooridul Spine Hospital, Seoul, Korea

§Wooridul Institute for Biomedical Science and Technology, Seoul, Korea.

Address correspondence and reprint requests to Ho-Yeon Lee, MD, PhD, Dep-artment of Neurosurgery, Wooridul Spine Hospital, 47-4 Cheongdam-Dong, Gangnam-Gu, Seoul, 130-100, South Korea; E-mail: mediple@yahoo.co.kr

Acknowledgment date: May 18, 2010. First revision date: January 6, 2011. Second revision date: March 21, 2011. Acceptance date: March 23, 2011.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

© 2012 Lippincott Williams & Wilkins, Inc.