SURGICAL TREATMENT IN LUMBAR SPONDYLOLISTHESIS: EXPERIENCE WITH 45 PATIENTS
Abstract
Background: Spondylolithesis is forward slipping of upper vertebra in relation to its lower one, whichat times requires surgery. The objective of present study is to document the outcome of surgical
treatment in spondylolisthesis of lumbosacral region. Methods: We reviewed outcome of surgery in 45
patients with spondylolisthesis. Improvement in pain intensity, neurological status and union achieved
after surgery was studied. All patients requiring surgical treatment were included in the study. The
patients were operated by single spine surgeon. A Performa was made for each patient and records
were kept in a custom built Microsoft access database. Results: Majority of our patient were in 4th and
5th decade with some male domination. Pain was main indication for surgery which was excruciating in
6, severe in 33, and moderate in 6 cases. The neurological status was normal in 34 cases while 11
patients had some deficit. L5-S1 was affected in 26, L4-L5 in 13 and multi or high level was found in
rest of cases. Slip grade was measured with Meyerding grades, 18 had grade II, 15 had I, 9 had III and 3
had IV spondylolisthesis. Posterior lumbar inter body fusion (PLIF) was done in 24 patients,
posterolateral, transforaminal lumbar inter body and anterior inter body fusion in others. Translaminar
screw fixation, transpedicular transdiscal transcorporial and Delta fixation in some cases. Pedicle screw
fixation was done in most cases, AO fixator internae and 4.5 mm screw in others. Average follow up
was 2 years and 5 months, max 5 years and minimum 6 months. Pain relief was achieved in 82%,
neurological improvement 60% and union in 91% cases. There was no deterioration of neurological
status, two implant failure and one wound infection. Conclusion: Surgical procedure for
Spondylolisthesis must be individualised. Young patients with spondylolysis can be treated with
osteosynthesis and sparing of motion segment. PLIF provides satisfactory results in majority of low to
moderate cases with some reduction. Transpedicular transdiscal transcorprial and delta fixation is good
procedure for severe slips in adult.
Keywords: Spondylolisthesis, Spondylolysis, Pedicle screw fixation, Posterior lumbar inter body fusion
References
Wiltse LL, Newman PH, Macnab I. Classification of
spondylolisis and spondylolisthesis. Clin Orthop Relat Res
;(117):23-9.
Meyerding HW. Spondylolisthesis. Surg Gynecol Obstet
;54:371-80.
Bridwell KH. Surgical treatment of high-grade
spondylolisthesis. Neurosurg Clin N Am 2006;17(3):331-8.
Jackson RP, Phipps T, Hales C, Surber J. Pelvic lordosis and
alignment in spondylolisthesis. Spine (Phila Pa 1976)
;28(2):151-60.
Rowe GG, Roche MB. The etiology of seprate neural arch. J
Bone Joint Surg Am 1953;35:102-10.
Syrmou E, Tsitsopoulos PP, Marinopoulos D, Tsonidis C,
Anagnostopoulos I, Tsitsopoulos PD. Spondylolysis: a
review and reappraisal. Hippokratia 2010;14(1):17-21.
Labelle H, Mac-Thiong JM, Roussouly P. Spino-pelvic
sagittal balance of spondylolisthesis: a review and
classification. Eur Spine J 2011;5:641-6.
Huang KY, Lin RM, Lee YL, Li JD. Factors affecting
disability and physical function in degenerative lumbar
spondylolisthesis of L4-5: evaluation with axially loaded
MRI. Eur Spine J 2009;18(12):1851-7.
Huang KY, Lin RM, Lee YL, Li JD. Factors affecting
disability and physical function in degenerative lumbar
spondylolisthesis of L4-5: evaluation with axially loaded
MRI. Eur Spine J 2009;18(12):1851-7.
Pearson AM, Lurie JD, Blood EA, Frymoyer JW, Braeutigam H,
An H, et al. Spine patient outcomes research trial: radiographic
predictors of clinical outcomes after operative or nonoperative
treatment of degenerative spondylolisthesis. Spine (Phila Pa
2008;33(25):2759-66.
Rajasekaran S, Subbiah M, Shetty AP. Direct repair of
lumbar spondylolysis by Buck's technique. Indian J Orthop
;45(2):136-40.
Debusscher F, Troussel S. Direct repair of defects in lumbar
spondylolysis with a new pedicle screw hook fixation:
clinical, functional and Ct-assessed study. Eur Spine J
;16(10):1650-8.
Kotil K, Akcetin M, Tari R, Ton T, Bilge T. Replacement of
vertebral lamina (laminoplasty) in surgery for lumbar isthmic
spondylolisthesis. A prospective clinical study. Turk
Neurosurg 2009;19(2):113-20.
Kim DH, Jeong ST, Lee SS. Posterior lumbar interbody
fusion using a unilateral single cage and a local morselized
bone graft in the degenerative lumbar spine. Clin Orthop
Surg 2009;1(4):214-21.
Hioki A, Miyamoto K, Hosoe H, Sugiyama S, Suzuki N,
Shimizu K. Cantilever transforaminal lumbar interbody
fusion for upper lumbar degenerative diseases (minimum 2
years follow up). Yonsei Med J 2011;52(2):314-21.
Lee DY, Lee SH, Maeng DH. Two-level anterior lumbar
interbody fusion with percutaneous pedicle screw fixation: a
minimum 3-year follow-up study. Neurol Med Chir (Tokyo)
;50(8):645-50.
Zagra A, Giudici F, Minoia L, Corriero AS, Zagra L. Longterm results of pediculo-body fixation and posterolateral
fusion for lumbar spondylolisthesis. Eur Spine J
;18:151-5.
Aunoble S, Hoste D, Donkersloot P, Liquois F, Basso Y, Le
Huec JC. Video-assisted ALIF with cage and anterior plate
fixation for L5-S1 spondylolisthesis. J Spinal Disord Tech
;19:471-6.
Yu CH, Wang CT, Chen PQ. Instrumented posterior lumbar
interbody fusion in adult spondylolisthesis. Clin Orthop Relat
Res 2008;466:3034-43.
Heft MV, Parker SR. An experimental basis for revising the
graphic rating scale for pain. Pain 1984;19(2):153-61.
Marino RJ, Barros T, Biering-Sorensen F, Burns SP,
Donovan WH, Graves DE, et al. International standards for
neurological classification of spinal cord injury. J Spinal
Cord Med 2003;26:S50-S56.
Girardo M, Bettini N, Dema E, Cervellati S. Uninstrumented
posterolateral spinal arthrodesis: is it the gold standard
technique for I degrees and II degrees grade spondylolisthesis
in adolescence? Eur Spine J 2009;18:126-32.
Weinstein JN, Lurie JD, Tosteson TD, Zhao W, Blood EA,
Tosteson AN, et al. Surgical compared with nonoperative
treatment for lumbar degenerative spondylolisthesis. fouryear results in the Spine Patient Outcomes Research Trial
(SPORT) randomized and observational cohorts. J Bone Joint
Surg Am 2009;91:1295-304.
Rajasekaran S, Subbiah M, Shetty AP. Direct repair of
lumbar spondylolysis by Buck's technique. Indian J Orthop
;45(2):136-40.
Acosta FL, Jr., Ames CP, Chou D. Operative management of
adult high-grade lumbosacral spondylolisthesis. Neurosurg
Clin N Am 2007;18(2):249-54.
Lawhorne TW, III, Girardi FP, Mina CA, Pappou I, Cammisa
FP, Jr. Treatment of degenerative spondylolisthesis: potential
impact of dynamic stabilization based on imaging analysis.
Eur Spine J 2009;18:815-22.
Zagra A, Giudici F, Minoia L, Corriero AS, Zagra L. Longterm results of pediculo-body fixation and posterolateral
fusion for lumbar spondylolisthesis. Eur Spine J
;18:151-5.
Abbushi A, Cabraja M, Thomale UW, Woiciechowsky C,
Kroppenstedt SN. The influence of cage positioning and cage
type on cage migration and fusion rates in patients with
monosegmental posterior lumbar interbody fusion and
posterior fixation. Eur Spine J 2009;18:1621-8.
Downloads
Published
How to Cite
Issue
Section
License
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.
