Operative treatment of spondylolisthesis in children and adolescents with tight hamstrings syndrome.
Of 10 patients with spondylolisthesis of the fifth lumbar vertebra, 8 had characteristic tight hamstrings syndrome, and 4 showed a Grade IV slip. Sciatic pain was present in all cases. In 5 there were also signs of compression of the first sacral root. In 4 cases impaired pattern of walking was the first symptom. Extraperitoneal anterior interbody fusion was performed in 9 cases. Laminectomy was combined with posterior fusion in one. Posterior fusion alone was performed in another. The follow-up period ranged from 2 to 14 years. All patients were free from symptoms at the last follow-up examination and they had normal living patterns and physical activities. Fusion was obtained in every case. There were no complications in this series, except for one fatigue fracture of the neural arch of the vertebra one level above fusion, discovered at 6 months after the operation; this patient has had no symptoms in a period of time of 14 years since the operation. The above described excellent results of anterior fusion without reduction raises questions as to the necessity of extensive major surgical interventions to obtain operative reduction of the displacement in patients, even with Grade IV spondylolisthesis.