POSTERIOR LUMBAR INTERBODY FUSION FOR DOUBLE-SEGMENTAL BILATERAL ISTHMIC LUMBAR SPONDYLOLISTHESIS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

XINGWenhua ,  HUOHongjun , YANGXuejun , XIAOYulong , ZHAOYan , FUYu , ZHUYong , LIFeng , XINDaqi

Department of Spinal Surgery, the Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot Inner Mongolia, 010030, P. R. China;

Corresponding?author：

HUOHongjun, Email: huohongjun456@sina.com

Keywords：

Isthmic lumbar spondylolisthesis; Double segments; Posterior lumbar interbody fusion

DOI：

10.7507/1002-1892.20150321

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Objective To explore the effectiveness of posterior lumbar interbody fusion in the treatment of double-segmental bilateral isthmic lumbar spondylolisthesis. Methods Between February 2008 and December 2013, 17 patients with double-segmental bilateral isthmic lumbar spondylolisthesis were treated with posterior lumbar interbody fusion. There were 12 males and 5 females, with an age ranged 48-69 years (mean, 55.4 years). The disease duration ranged from 11 months to 17 years (median, 22 months). According to the Meyerding classification, 30 vertebrea were rated as degree I, 3 as degree Ⅱ, and 1 as degree Ⅲ. L_{4, 5} was involved in 14 cases and L_{3, 4} in 3 cases. The preoperative visual analogue scale (VAS) score was 8.6±3.2. Results Cerebrospinal fluid leakage occurred in 2 cases because of intraoperative dural tear; primary healing of incision was obtained, with no operation related complication in the other patients. The patients were followed up 1-6 years (mean, 3.4 years). At last follow-up, VAS score was decreased significantly to 1.1±0.4, showing significant difference when compared with preoperative score (t=7.652, P=0.008). X-ray films showed that slippage vertebral body obtained different degree of reduction, with a complete reduction rate of 85% (29/34) at 1 week after operation. All patients achieved bony union at 6-12 months (mean, 7.4 months). According to the Lenke classification, 13 cases were rated as grade A and 4 cases as grade B. No internal fixation loosening and fracture were observed during the follow-up. Intervertebral disc height was maintained, no loss of spondylolisthesis reduction was found. Conclusion It can obtain satisfactory clinical result to use spinal canal decompression by posterior approach, and screw fixation for posterior fusion in treatment of double-segmental bilateral isthmic lumbar spondylolisthesis. The key points to successful operation include accurate insertion of screw, effective decompression, distraction before reduction, rational use of pulling screws, and interbody fusion.

Citation： XINGWenhua, HUOHongjun, YANGXuejun, XIAOYulong, ZHAOYan, FUYu, ZHUYong, LIFeng, XINDaqi. POSTERIOR LUMBAR INTERBODY FUSION FOR DOUBLE-SEGMENTAL BILATERAL ISTHMIC LUMBAR SPONDYLOLISTHESIS. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(12): 1500-1503. doi: 10.7507/1002-1892.20150321 Copy

1.	鄒德威, 海涌, 馬華松, 等. 重度腰椎滑脫的治療. 中華骨科雜志, 1998, 18(5):259-262.
2.	付忠泉, 關宏剛, 曹正霖, 等. 多節段腰椎峽部裂并滑脫的后路融合方式選擇. 中外醫學研究, 2014, 12(22):120-121.
3.	Blumenthal C, Curran J, Benzel EC, et al. Radiographic predictors of delayed instability following decompression without fusion for degenerative grade Ⅰ lumbar spondylolisthesis. J Neurosurg Spine, 2013, 18(4):340-346.
4.	占道祿, 沈寧江, 林明俠, 等. 椎弓根釘固定聯合PLIF手術治療多節段腰椎滑脫的療效分析. 實用骨科雜志, 2013, 19(3):193-195.
5.	Kalichman L, Kim DH, Guermazi A, et al. Spondylolysis and spondylolisthesis:prevalence and association with low back pain in the adult community-based population. Spine (Phila Pa 1976), 2009, 34(2):199-205.
6.	Lenke L, Bridwell KH. Adult spondylolisthesis with lysis//Bridwell KH. The texbook of spinal surgery. Philadelphia:Lippcottraven, 1997:1269-1298.
7.	王春, 林永綏, 劉成招, 等. 重度腰椎滑脫癥的手術治療. 中國骨與關節損傷雜志, 2011, 26(1):29-31.
8.	潘劍成, 龔旭, 羅飛. 同種異體骨椎間融合器的研究進展及臨床應用現狀. 中國修復重建外科雜志, 2015, 29(3):381-385.
9.	龔全, 孔清泉, 李濤, 等. 后路復位技術在重度腰椎滑脫癥治療中的應用. 中國修復重建外科雜志, 2013, 27(4):393-398.
10.	Kasliwal MK, Smith JS, Shaffrey CI, et al. Short-term complications associated with surgery for high-grade spondylolisthesis in adults and pediatric patients:a report from the scoliosis research society morbidity and mortality database. Neurosurgery, 2012, 71(1):109-116.
11.	Schuller S, Charles YP, Steib JP. Sagittal spinopelvic alignment and body mass index in patients with degenerative spondylolisthesis. Eur Spine J, 2011, 20(5):713-719.
12.	Uysal M, Cirei E, Ozalay M, et al. The surgical treatment for a rare case of double-level isthmic spondylolisthesis in L4 and L5 lumbar spine:deeompression, reduetion and fusion. Eur J Orthop Surg Traumatol, 2012, 22(1):21-24.
13.	荊丹峰, 許藝薺, 孫太存, 等. 骨水泥注入中空側孔椎弓根螺釘內固定骨質疏松性腰椎退變:強化技術要點. 中國組織工程研究, 2014, 18(47):7556-7560.
14.	滕海軍, 王亮, 郭志良, 等. Quadrant通道下單切口治療腰椎滑脫近期療效觀察. 中國修復重建外科雜志, 2010, 24(5):517-520.
15.	劉勇, 劉臻, 朱鋒, 等. 成人腰椎峽部裂性滑脫癥與退變性滑脫癥患者脊柱骨盆矢狀面形態學研究. 中國脊柱脊髓雜志, 2013, 23(4):307-311.
16.	黃衛國, 海涌. 退行性腰椎滑脫癥與峽部裂性腰椎滑脫癥患者的手術療效比較. 中國骨與關節雜志, 2014, 3(6):460-465.
17.	鎬英杰, 于磊, 張巖, 等. Luxo通道下經椎間孔減壓椎間植骨融合聯合Mantis釘棒系統治療中重度腰椎滑脫癥. 中國修復重建外科雜志, 2014, 28(12):1509-1513.
18.	胡學峰, 田先柱, 任威, 等. 雙節段腰椎退行性前滑脫的手術治療. 中國骨與關節損傷雜志, 2013, 28(1):64-65.

1. 鄒德威, 海涌, 馬華松, 等. 重度腰椎滑脫的治療. 中華骨科雜志, 1998, 18(5):259-262.
2. 付忠泉, 關宏剛, 曹正霖, 等. 多節段腰椎峽部裂并滑脫的后路融合方式選擇. 中外醫學研究, 2014, 12(22):120-121.
3. Blumenthal C, Curran J, Benzel EC, et al. Radiographic predictors of delayed instability following decompression without fusion for degenerative grade Ⅰ lumbar spondylolisthesis. J Neurosurg Spine, 2013, 18(4):340-346.
4. 占道祿, 沈寧江, 林明俠, 等. 椎弓根釘固定聯合PLIF手術治療多節段腰椎滑脫的療效分析. 實用骨科雜志, 2013, 19(3):193-195.
5. Kalichman L, Kim DH, Guermazi A, et al. Spondylolysis and spondylolisthesis:prevalence and association with low back pain in the adult community-based population. Spine (Phila Pa 1976), 2009, 34(2):199-205.
6. Lenke L, Bridwell KH. Adult spondylolisthesis with lysis//Bridwell KH. The texbook of spinal surgery. Philadelphia:Lippcottraven, 1997:1269-1298.
7. 王春, 林永綏, 劉成招, 等. 重度腰椎滑脫癥的手術治療. 中國骨與關節損傷雜志, 2011, 26(1):29-31.
8. 潘劍成, 龔旭, 羅飛. 同種異體骨椎間融合器的研究進展及臨床應用現狀. 中國修復重建外科雜志, 2015, 29(3):381-385.
9. 龔全, 孔清泉, 李濤, 等. 后路復位技術在重度腰椎滑脫癥治療中的應用. 中國修復重建外科雜志, 2013, 27(4):393-398.
10. Kasliwal MK, Smith JS, Shaffrey CI, et al. Short-term complications associated with surgery for high-grade spondylolisthesis in adults and pediatric patients:a report from the scoliosis research society morbidity and mortality database. Neurosurgery, 2012, 71(1):109-116.
11. Schuller S, Charles YP, Steib JP. Sagittal spinopelvic alignment and body mass index in patients with degenerative spondylolisthesis. Eur Spine J, 2011, 20(5):713-719.
12. Uysal M, Cirei E, Ozalay M, et al. The surgical treatment for a rare case of double-level isthmic spondylolisthesis in L4 and L5 lumbar spine:deeompression, reduetion and fusion. Eur J Orthop Surg Traumatol, 2012, 22(1):21-24.
13. 荊丹峰, 許藝薺, 孫太存, 等. 骨水泥注入中空側孔椎弓根螺釘內固定骨質疏松性腰椎退變:強化技術要點. 中國組織工程研究, 2014, 18(47):7556-7560.
14. 滕海軍, 王亮, 郭志良, 等. Quadrant通道下單切口治療腰椎滑脫近期療效觀察. 中國修復重建外科雜志, 2010, 24(5):517-520.
15. 劉勇, 劉臻, 朱鋒, 等. 成人腰椎峽部裂性滑脫癥與退變性滑脫癥患者脊柱骨盆矢狀面形態學研究. 中國脊柱脊髓雜志, 2013, 23(4):307-311.
16. 黃衛國, 海涌. 退行性腰椎滑脫癥與峽部裂性腰椎滑脫癥患者的手術療效比較. 中國骨與關節雜志, 2014, 3(6):460-465.
17. 鎬英杰, 于磊, 張巖, 等. Luxo通道下經椎間孔減壓椎間植骨融合聯合Mantis釘棒系統治療中重度腰椎滑脫癥. 中國修復重建外科雜志, 2014, 28(12):1509-1513.
18. 胡學峰, 田先柱, 任威, 等. 雙節段腰椎退行性前滑脫的手術治療. 中國骨與關節損傷雜志, 2013, 28(1):64-65.

Chinese Journal of Reparative and Reconstructive Surgery

POSTERIOR LUMBAR INTERBODY FUSION FOR DOUBLE-SEGMENTAL BILATERAL ISTHMIC LUMBAR SPONDYLOLISTHESIS

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