Pediatric thesis topics

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The clinical situation is consistent with neurogenic claudication due to degenerative spondylolithesis at L4/5. Decompression with a laminectomy and instrumented fusion is the most appropriate treatment.

Weinstein et al performed a randomized and observational cohort study comparing standard decompressive laminectomy (with or without fusion) to nonsurgical care for the treatment of degenerative spondylolithesis. They found patients treated surgically maintain substantially greater pain relief and improvement in function for four years.

Herkowitz et al prospectively studied 50 patients with degenerative spondylolithesis to determine if concomitant intertransverse-process arthrodesis provided better results than decompressive laminectomy alone. They found that the arthrodesis group had significantly better results with respect to relief of pain in the back and lower limbs at an average follow-up of 3 years.

Fischgrund et al shows that in patients undergoing single-level posterolateral fusion for degenerative spondylolisthesis with spinal stenosis, the use of pedicle screws leads to a higher fusion rate.

Wrong Answers:
Answer 1: The patient has failed nonoperative management and her symptoms are affecting her quality of life. In addition, he has neurologic deficits, so operative treatment is indicated.
Answer 2: Posterior decompression alone for the treatment of mobile degenerative spondylolisthesis (DS) can lead to iatrogenic instability, and is not appropriate.
Answer 3: The patient's neurogenic claudication is caused by spinal stenosis, and a microdiskectomy would not address this.
Answer 5: An ALIF would not adequately decompress the spinal canal and is not the most appropriate treatment.

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Pediatric thesis topics

pediatric thesis topics

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