ObjectiveTo compare the effectiveness of vertebral arch replantation and laminectomy in the treatment of mild to moderate isthmic spondylolisthesis.MethodsThe clinical data of 66 patients with isthmic spondylolisthesis treated with vertebral arch replantation or laminectomy between March 2014 and July 2016 were retrospectively analyzed. They were divided into trial group (34 cases, treated with complete replantation of vertebral arch, intervertebral fusion, and internal fixation) and control group (32 cases, treated with laminectomy with intervertebral fusion and internal fixation) according to different surgical methods. There was no significant difference in general data of gender, age, disease duration, lesion segment, Meyerding grade, and preoperative visual analogue scale (VAS) score, Oswestry disability index (ODI) score, Japanese Orthopaedic Association (JOA) score between the two groups (P>0.05). The operation time, intraoperative blood loss, complications, vertebral arch fusion of trial group, and epidural scar formation of the two groups were recorded. The VAS score, JOA score, and ODI score were evaluated at preoperation, 3, 6, 12 months after operation, and at last follow-up. The effectiveness was evaluated according to HOU Shuxun’s criteria.ResultsAll the patients successfully completed the surgery, without any aggravation of nerve injury, dural tear, infection, etc. There was no significant difference in the operation time between the two groups (t=0.583, P=0.562), but the intraoperative blood loss was significantly lower in the trial group than that in the control group (t=2.134, P=0.037). All the 66 patients were followed up 13-18 months (mean, 16.2 months). Postoperative clinical symptoms of all patients were significantly improved. In the control group, 7 cases were found to have symptoms of spinal canal stenosis with postoperative posture changes at 3 months after operation, and 5 cases showed mild lower limb numbness at 18 months after operation. No complication such as infection and nerve injury occurred in other patients. In the trial group, 34 cases of epidural scar tissue were completely blocked outside the replantation vertebral arch, while in the control group, 11 cases of epidural scar tissue invaded the spinal canal. At last follow-up, the fusion rate of intervertebral bone grafting and vertebral arch replantation in the trial group was 100%, and the fusion rate of intervertebral bone grafting in the control group was also 100%. The VAS score, ODI score, and JOA score were significantly improved at each time point after operation (P<0.01). The ODI score and JOA score of the trial group were significantly better than those of the control group at 3 months after operation and at last follow-up (P<0.05), and there was no significant difference in scores between the two groups at other time points (P>0.05). According to HOU Shuxun’s criteria, the excellent and good rate was 91.2% in the trial group and 84.4% in the control group, showing no significant difference (χ2=1.092, P=0.573).ConclusionCompared with laminectomy, vertebral arch replantation can better improve postoperative neurological symptoms, maximize the reconstruction of the bone spinal canal, restore the stability of the intraspinal environment, and it is a better surgical method for lumbar isthmic spondylolisthesis.
ObjectiveTo evaluate the effectiveness of transforaminal lumbar interbody fusion (TLIF) via Luxor retractor associated with Mantis pedicle screw for the treatment of moderate or severe lumbar spondylol isthesis (LSL). MethodsA retrospective analysis was made on the cl inical data of 32 patients with LSL treated with TLIF via Luxor retractor associated with Mantis pedicle screw between June 2010 and June 2012. There were 20 males and 12 females, with the mean age of 48 years (range, 36-69 years). LSL occurred at the L4, 5 in 17 patients and at the L5, S1 in 15 patients. Of them, 18 cases were rated as Meyerding grade Ⅱ, and 14 cases as grade Ⅲ. The disease duration was 8 months to 6 years (mean, 3.5 years). The operation time, intraoperative blood loss, and preoperative and postoperative (1 week and 1 year) intervertebral height and sl ipping angle were recorded, and the sl ipping rate was calculated; Japanese Orthopaedic Association (JOA) score was used for cl inical efficacy assessment. ResultsThe operation time was 90-130 minutes (mean, 110 minutes); intraoperative blood loss was 120-300 mL (mean, 210 mL). Incisions healed by first intention. All patients were followed up 24-36 months (mean, 28 months), and no complications of leakage of cerebrospinal fluid and nerve root injury occurred; X-ray films showed satisfactory reduction of spondylolisthesis and good position of pedicle screw and interbody fusion cage. The mean bone fusion time was 4.0 months (range, 3.8-6.0 months). The JOA score, sl i pping rate, sl i pping angle, and intervertebral height at 1 week and 1 year after operation were significantly improved when compared with preoperative ones (P<0.05), but no significant difference was found between at 1 week and at 1 year after operation (P>0.05). ConclusionTLIF via Luxor retractor associated with Mantis pedicle screw fixation is a safe and effective minimally invasive technique in treating moderate or severe LSL.
Objective To investigate the relationship between the volume of bone-graft and fusion efficacy in posterior lumbar interbody fusion and internal fixation of spondylolisthesis. Methods Between May 2004 and June 2007, 79 patients with spondylolisthesis were treated with posterior lumbar interbody fusion and internal fixation. The patients were randomly divided into 3 groups according to the volume of bone-graft for interbody fusion: group A (n=27), 5 bone granules/ cm3 on average; group B (n=26), 11 bone granules/cm3 on average; and group C (n=26), 25 bone granules/cm3 on average. There was no significant difference in gender, age, disease duration, affected segment, and the degree of vertebral slip among 3 groups (P gt; 0.05). The volume of bone-graft, the fusion rate, the loss of intervertebral height, and the incidence of internal fixation failure were compared among 3 groups. Results All cases were followed up 24-43 months (mean, 35 months). There were significant differences in volume of bone-graft among 3 groups (P lt; 0.05). There was no significant difference in total volume of bone-graft and Cage height among 3 groups (P gt; 0.05). The Oswestry disability index (ODI) and visual analogue scale (VAS) scores of low back pain and leg pain at last follow-up were significantly decreased when compared with preoperative scores in 3 groups (P lt; 0.05); but no significant difference was found among 3 groups (P gt; 0.05). The fusion rate was significantly higher in group B than in groups A and C, and in group A than in group C at 1 and 2 years after operation (P lt; 0.05). The change values of the intervertebral height were (2.2 ± 1.4), (0.8 ± 1.3), and (2.3 ± 1.6) mm respectively in groups A, B, and C; it was significantly lower in group B than in groups A and C (P lt; 0.05). The degree of vertebral slip at immediately after operation and last follow-up was significantly improved when compared with preoperative one in 3 groups (P lt; 0.05); the loss of vertebral slip in group B was significantly lower than that in groups A and C at last follow-up (P lt; 0.05). After operation, nail breaking occurred in 1 case (3.7%) of group C at 1 year, depinning in 1 case (3.8%) of group A at 2 years, and no nail breaking or depinning in group B. There was no significant difference in the incidence of internal fixation failure among 3 groups (χ2=3.950, P=0.604). Conclusion The application of bone-graft with middle volume (11 bone granules/cm3 on average) in internal fixation and posterior lumbar interbody fusion has a good imageology outcome, which can increase the fusion rate and decrease the loss of intervertebral height.
ObjectiveTo explore a better segment of fixation and fusion for high-grade spondylolisthesis. MethodsA total of 21 patients with high-grade spondylolisthesis who had undergone reduction and posterior instrumented fusion between July 2007 and March 2012, were retrospectively reviewed. All cases underwent posterior spinal canal decompression, Schanz screws fixation and reduction, and intervertebral and posterolateral fusion. The concept of "unstable zone" and the feature of spinal deformity helped us to identify the most appropriate segment to fuse. The pre/post-operative differences on slip percentage, pelvic incidence (PI) and lumbosacral angle were compared and analyzed. The nerve function was evaluated by physical examination and neurological Frankel grade. The Visual Analogue Scale (VAS) and Oswestry Disability Index were used to assess clinical and functional outcomes of lower limbs. Bone fusion was assessed using CT reconstruction. ResultsAll patients were followed up between 12 and 48 months. The clinical and radiological outcomes such as VAS scores and PI angle were all improved compared with that of preoperative, and the differences were all statistically significant (P<0.05). ConclusionFor children with severe spondylolisthesis, if not combined with structural scoliosis, the fixation and fusion level should be up to the upper vertebra which PI angle>60°, and try to protect the posterior longitudinal ligament complex in case adjacent segments become instability or even slip. For adults with severe spondylolisthesis, if not combined with other spinal disorders such as severe osteoporosis, only mono-segmental fusion is recommended after reduction. If the slipped vertebrae could not be reduced to Meyerding gradeⅠ, two or more segments would need to be fixed and fused.
BJECTIVE: To discuss the clinical effect and the application of AF device fixation system and PROSPACE interbody fusion cage on treating lumbar spondylolisthesis. METHODS: Twenty-one cases of lumbar spondylolisthesis treated by operation from 1999 to 2002 were analyzed retrospectively (13 males and 8 females, 25-66 years old averaging 42 years). We had thorough decompression on the part of nerve compression and had replacement and fixation of the slippage vertebral body with the AF transpedicular screw/rod system so that the normal spine physiological curvature could be recovered, and then performed the posterolateral interbody fusion with implanting the PROSPACE filled with autograft bones. RESULTS: All the patients were followed up for 3 months to 3 years with an average of 15 months. The preoperation symptoms improved in 20 cases (95.2%). CONCLUSION: The combination of AF device fixation system and PROSPACE interbody fusion cage can relieve effectively nerve compression, recover the normal spinal physiological curvature, maintain the height of interbody and promote the nerve fusion. It is reliable and effective in the treatment of spondylolisthesis.
Objective To compare the effectiveness of posterolateral approach lumbar interbody fusion assisted by one-hole split endoscope (OSE) and traditional posterior lumbar interbody fusion (PLIF) in the treatment of L4, 5 degenerative lumbar spondylolisthesis (DLS). Methods The clinical data of 58 patients with DLS who met the selection criteria admitted between February 2020 and March 2022 were retrospectively analyzed, of which 26 were treated with OSE-assisted posterolateral approach lumbar interbody fusion (OSE group) and 32 were treated with PLIF (PLIF group). There was no significant difference between the two groups in terms of gender, age, body mass index, Meyerding grade, lower limb symptom side, decompression side, stenosis type, and preoperative low back pain visual analogue scale (VAS) score, leg pain VAS score, Oswestry disability index (ODI), and the height of the anterior and posterior margins of the intervertebral space (P>0.05). The operation time, intraoperative blood loss, postoperative hospital stay, and complications were compared between the two groups. The low back pain and leg pain VAS scores and ODI before operation, at 1 month, 6 months after operation, and last follow-up, the height of anterior and posterior margins of the intervertebral space before operation, at 6 months after operation, and last follow-up, the modified MacNab criteria at last follow-up after operation were used to evaluate the effectiveness; and the Bridwell method at last follow-up was used to evaluate the interbody fusion. Results Both groups successfully completed the operation. Compared with the PLIF group, the OSE group showed a decrease in intraoperative blood loss and postoperative hospital stay, but an increase in operation time, with significant differences (P<0.05). In the OSE group, no complication such as nerve root injury and thecal sac tear occurred; in the PLIF group, there were 1 case of thecal sac tear and 1 case of epidural hematoma, which were cured after conservative management. Both groups of patients were followed up 13-20 months with an average of 15.5 months. There was no complication such as loosening, sinking, or displacement of the fusion cage. The low back pain and leg pain VAS scores, ODI, and the height of anterior and posterior margins of the intervertebral space at each time point after operation in both groups were significantly improved when compared with those before operation (P<0.05). Except for the VAS score of lower back pain in the OSE group being significantly better than that in the PLIF group at 1 month after operation (P<0.05), there was no significant difference in all indicators between the two groups at all other time points (P>0.05). At last follow-up, both groups achieved bone fusion, and there was no significant difference in Bridwell interbody fusion and modified MacNab standard evaluation between the two groups (P>0.05). Conclusion OSE-assisted posterolateral approach lumbar interbody fusion for L4, 5 DLS, although the operation time is relatively long, but the postoperative hospitalization stay is short, the complications are few, the operation is safe and effective, and the early effectiveness is satisfactory.
ObjectiveTo investigate the early effctiveness of oblique lateral interbody fusion (OLIF) combined with pedicle screw fixation via small incision Wiltse approach for the treatment of lumbar spondylolisthesis.MethodsBetween January 2016 and December 2016, 21 patients with lumbar spondylolisthesis were treated with OLIF and pedicle screw fixation via small incision Wiltse approach. There were 9 males and 12 females, aged 57-73 years, with an average age of 64.5 years. The disease duration was 24-60 months, with an average of 34.6 months. All cases were spondylolisthesis at L4 (15 cases of degreeⅠ, 6 cases of degreeⅡ); 1 case had vertebral arch isthmus, and 20 cases had spinal stenosis. Japanese Orthopaedic Association (JOA) scoring system was used to evaluate the effectiveness before operation and at last follow-up. Before operation and at 2 days after operation, anteroposterior and lateral X-ray films and CT were taken to measure the sagittal diameter and cross-sectional area of the spinal canal, and calculate the intervertebral height and degree of spondylolisthesis. At 6 months after operation, the intervertebral fusion was evaluated by CT.ResultsThe operation time was 120-180 minutes, with an average of 155 minutes; the intraoperative blood loss was 100-340 mL, with an average of 225.5 mL. One patient had slight injury of lower endplate, 1 patient had numbness of thigh and weakness of hip flexion after operation, 1 patient had sympathetic nerve trunk injury. All the cases were followed up 12-18 months, with an average of 14.3 months. The symptoms of low back pain, leg pain, and numbness of lower limbs significantly relieved after operation, and there was no complication such as protrusion of fusion cage, screw breakage, and endplate collapse. At 2 days after operation, the intervertebral height, degree of spondylolisthesis, sagittal diameter of spinal canal, and cross-sectional area of spinal canal significantly improved compared with preoperative ones (P<0.05). At 6 months after operation, CT showed that 1 patient had poor interbody fusion (grade Ⅲ), the other 20 patients had good interbody fusion (grade Ⅰ and Ⅱ), and the interbody fusion rate was 95.2%. At last follow-up, JOA score of lumbar spine significantly increased compared with that before operation (t=24.980, P=0.000).ConclusionOLIF combined with pedicle screw fixation via small incision Wiltse approach for the lumbar spondylolisthesis has minimally invasive features, such as less trauma, fewer complications, and higher intervertebral fusion rate. It is a safe and effective method.
Lumbar spondylolisthesis is a common condition in spinal surgery, which is often characterized by lower back and leg pain and numbness. There are various treatment methods for this condition, and different treatment plans should be adopted according to different situations. Traditional open surgery methods are relatively traumatic and have longer recovery times, while minimally invasive spine techniques have advantages such as smaller incisions, less bleeding, higher fusion rates, and faster recovery. This review summarizes the relevant literature on the application of minimally invasive techniques in the treatment of lumbar spondylolisthesis in recent years, analyzes and compares the advantages and disadvantages of different approaches and endoscopic techniques, as well as reduction, decompression, and fusion effects. The aim is to provide reference for surgeons in selecting surgical procedures for the treatment of lumbar spondylolisthesis.
ObjectiveTo investigate the correlation between the effectiveness and the changes of spine-pelvic sagittal parameters for patients with spondylolisthesis before and after operation. MethodsA retrospective analysis was made on the clinical data of 32 patients with single segmental degenerative lumbar spondylolisthesis at L4 who accorded with the inclusion criteria between June 2011 and January 2014 (trial group). There were 13 males and 19 females, aged 51-67 years (mean, 59 years). According to Meyerding degree, there were 21 cases of degree I, 10 cases of degree Ⅱ, and 1 case of degree Ⅲ. All patients were treated with transforaminal lumbar interbody fusion (TLIF) surgery. Thirty-five healthy adults at the age of 46-67 years (mean, 57 years) were enrolled as normal controls (control group). The standing position lumbar lateral X-ray films (T12-S1, bilateral femoral head) were taken at pre- and post-operation to measure the pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), disc height (DH), and slip percentage (SP); the visual analogue scale (VAS) and Oswestry disability index (ODI) were recorded. Pearson correlation analysis was used to analyze the correlation between the preoperative various spine-pelvic sagittal parameters and the VAS score and the ODI. After operation, Pearson correlation analysis was used to evaluate the correlation between the changes of these parameters and the improve rates of VAS score and ODI. ResultsAll patients of trial group were followed up 15-22 months (mean, 18 months). At last follow-up, the VAS score, ODI, PT, SS, LL, SP, and DH were significantly improved when compared with preoperative values (P<0.05), except for PI (t=-1.445, P=0.158). There was no significant difference in PT, SS, LL, and DH between trial and control groups at last follow-up (P>0.05); PI was slightly bigger than that of control group (t=8.531, P=0.043). Pearson correlation analysis showed that there was a correlation between spine-pelvic sagittal parameters of PI, PT, SS, and LL (P<0.05); preoperative parameters (except for LL and DH) had correlation with ODI and VAS scores (P<0.05). Postoperative parameters (except for PI) had correlation with the improve rates of ODI and VAS scores (P<0.05), especially for the changes of PT and the improvements of ODI and VAS scores. ConclusionThere is a correlation between the changes of spine-pelvic sagittal parameters at pre- and post-operation and effectiveness in patients with lumbar spondylolisthesis. The correlation between the changes of PT and the improvement rates of ODI and VAS scores is more marked. The good effectiveness is closely related with the improved PT.
ObjectiveTo investigate the effectiveness of minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) assisted with microscope in treatment of lumbar spondylolisthesis. MethodsBetween January 2011 and June 2012, 52 patients with lumbar spondylolisthesis underwent MI-TLIF assisted with microscope. There were 29 males and 23 females with an average age of 46 years (range, 32-67 years). The median disease duration was 3.2 years (range, 3 months to 6 years). There were 38 cases of lumbar isthmic spondylolisthesis and 14 cases of degenerative spondylolisthesis; 12 cases had stenosis secondary to lumbar spondylolisthesis. The affected segments were L4, 5 (29 cases) and L5, S1 (23 cases). According to the Meyerding evaluating system, 24 cases were classified as degree I and 28 cases as degree Ⅱ. The visual analogue scale (VAS) score and Oswestry disability index (ODI)were used for clinical assessment, and the clinical effects were also analyzed by Macnab criterion at last follow-up. The radiographic data were used to evaluate reduction of spondylolisthesis, including slipping degree, slipping angle, and intervertebral space height. The fusion rate was assessed by Suk criterion. ResultsThe operations were performed successfully in all patients. No dural tear or cerebrospinal fluid leakage occurred during operation. The average operation time was 105 minutes; the average intraoperative blood loss was 225 mL; the average postoperative drainage volume was 75 mL; and the average hospitalization days were 5.5 days. Superficial infection of incision occurred in 1 case and was cured after change dressing, and primary healing of incision was obtained in the others. All patients were followed up 12-26 months (mean, 18 months). No loosening, breakage, and displacement of pedicle screw and no Cage dislocation occurred by X-ray films after operation. The lumbar spondylolisthesis all got good correction. The three-dimensional CT showed continuous bone trabecula between centrums. The VAS score, ODI, and the slipping degree, slipping angle, and intervertebral space height were significantly improved at last follow-up when compared with preoperative ones (P<0.05). According to Macnab criterion at last follow-up, the results were excellent in 20 cases, good in 29 cases, and fair in 3 cases; the excellent and good rate was 94.2%. According to Suk criterion for fusion, 49 cases obtained complete fusion and 3 cases got possible fusion. ConclusionAs long as indications are seized, MI-TLIF assisted with microscope is safe and reliable for treatment of lumbar spondylolisthesis (Meyerding dergee I or Ⅱ), and it has the advantage of less injury, less blood loss, less complications, and definite short-term effectiveness.