BACKGROUND The current literature investigating surgical treatments for lumbar spondylolisthesis in adolescent patients is limited by small sample sizes. There are high reoperation rates, and posterior interbody fusion has not been reported to help. The current study aimed to utilize a nationwide database to investigate outcomes of spinal fusion for spondylolisthesis in young patients. METHODS The PearlDiver database was queried for patients <21 years old who had undergone lumbar spinal fusion for spondylolisthesis between 2010 and 2020. Patients were divided into 4 cohorts based on surgical approach: (1) posterior spinal fusion with posterior instrumentation (PSF), (2) posterior spinal fusion with posterior instrumentation plus interbody (PSF+I), (3) anterior spinal fusion without posterior instrumentation (ASF), and (4) anterior spinal fusion plus posterior instrumentation (A+PSF). Patients with <2 years of follow-up were excluded. The primary outcome was reoperation. RESULTS Of 33,945 patients with spondylolisthesis, 578 (1.7%) underwent lumbar spinal fusion: 236 (40.8%) had PSF, 219 (37.9%) had PSF+I, 66 (11.4%) had ASF, and 57 (9.9%) had A+PSF. The mean age was 16.5 ± 1.1 years, and the mean follow-up was 5.4 ± 2.9 years. A higher percentage of girls underwent surgery compared with boys (2.0% versus 1.4%). Survival analysis using all-cause reoperation as the end point demonstrated an overall 5-year reoperation-free survival rate of 85.5% (95% confidence interval [CI]: 82.5% to 88.6%). The overall reoperation rate within 5 years was significantly different depending on the approach, with A+PSF being the lowest at 7.0% (PSF = 11.9%, PSF+I = 10.5%, and ASF = 31.8%). CONCLUSIONS This is the largest reported series of spondylolisthesis surgery in young people. The lowest rate of revisions within 5 years was for a combined approach of A+PSF. The 5-year risk of reoperation of 31.8% for a stand-alone ASF appeared to be unacceptably high compared with other approaches, and was over 4 times higher than A+PSF (7.0%). Consistent with previous clinical series, the addition of an interbody fusion to a PSF did not decrease the reoperation rate and did not appear to offer any advantages to a PSF alone. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

中文翻译：

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大型全国队列中年轻患者的脊椎滑脱：再手术率取决于手术方法。


背景 目前调查青少年患者腰椎滑脱手术治疗的文献受到样本量小的限制。再手术率高，且后椎体间融合术没有帮助。目前的研究旨在利用全国数据库来调查脊柱融合治疗年轻患者脊椎滑脱的结果。方法 查询 PearlDiver 数据库以查找 2010 年至 2020 年间因腰椎滑脱而接受腰椎融合术的患者 <21 岁。根据手术入路将患者分为 4 个队列：（1） 后路脊柱融合术联合后路器械 （PSF），（2） 后路脊柱融合术联合后路器械加椎间器 （PSF+I），（3） 前路脊柱融合术，无后路器械 （ASF），以及 （4） 前路脊柱融合术加后路器械 （A+PSF）。排除了随访 <2 年的患者。主要结局是再次手术。结果 在 33,945 例脊椎滑脱患者中，578 例 （1.7%） 接受了腰椎融合术： 236 例 （40.8%） 患有 PSF，219 例 （37.9%） 患有 PSF+I，66 例 （11.4%） 患有 ASF，57 例 （9.9%） 患有 A+PSF。平均年龄为 16.5 ± 1.1 岁，平均随访时间为 5.4 ± 2.9 岁。与男孩相比，女孩接受手术的百分比更高 （2.0% 对 1.4%）。以全因再次手术为终点的生存分析显示，总体 5 年无手术生存率为 85.5% （95% 置信区间 [CI]： 82.5% 至 88.6%）。5 年内的总体再手术率因方法而异，其中 A+PSF 最低，为 7.0% （PSF = 11.9%，PSF+I = 10.5% 和 ASF = 31.8%）。结论 这是报道规模最大的年轻人滑脱手术系列。 5 年内最低的翻修率是 A+PSF 的组合方法。与其他方法相比，独立 ASF 的 5 年再次手术风险为 31.8%，似乎高得令人无法接受，并且比 A+PSF （7.0%） 高 4 倍以上。与以前的临床系列一致，在 PSF 中加入椎体间融合并没有降低再手术率，并且似乎没有为单独的 PSF 提供任何优势。证据级别 治疗 III 级。有关证据级别的完整描述，请参阅作者说明。