ObjectiveTo observe the character of spino-pelvic sagittal alignment in patients with high-grade L5 isthmic spondylolisthesis, and to analyze the sagittal alignment alteration after operation. MethodBetween January 2009 and June 2014, 25 patients with high-grade L5 isthmic spondylolisthesis underwent posterior surgery, and the clinical data were retrospectively analyzed as study group. There were 14 males and 11 females with a mean age of 42.5 years (range, 20-65 years). The mean disease duration was 6 months (range, 3-12 months). According to the Meyerding evaluating system, 15 cases were rated as degree III, and 10 cases as degree IV. Eighty healthy adult volunteers were recruited simultaneously as control group. The lumbar sacral angle (LSA), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), thoracic kyphosis (TK), and sagittal vertical axis (SVA) were measured on preoperative and last follow-up standing full length lateral X-ray films. And these parameters were compared between study group (preoperative parameters) and control group. Then the patients in study group were divided into 2 subgroups according to Hresko's method:the balanced pelvis subgroup (n=14) and unbalanced pelvis subgroup (n=11) . The sagittal parameters were compared between 2 subgroups, and the alteration of sagittal parameters before surgery and at last follow-up was analyzed in each subgroup respectively. ResultsAll patients in study group were followed up 18 months on average (range, 6-48 months). After surgery, spondylolisthesis was reduced from degree III to degree 0 in 12 cases and to degree I in 3 cases, and from degree IV to degree 0 in 6 cases and to degree I in 4 cases. Bone fusion was obtained in all patients at last follow-up. The preoperative PI, SS, PT, and SVA of study group were significantly greater than those of control group (P<0.05) , while the TK was significantly smaller than that of control group (P<0.05) . In the balanced pelvis subgroup, LSA, LL, and SVA at last follow-up significantly decreased while TK significantly increased when compared with preoperative ones (P<0.05) . In the unbalanced pelvis subgroup, LSA, PT, and SVA at last follow-up significantly decreased while SS, LL, and TK significantly increased when compared with preoperative ones (P<0.05) . The preoperative LSA and PT in the unbalanced pelvis subgroup were significantly greater, while SS, LL, and TK were significantly smaller than those of balanced pelvis subgroup (P<0.05) ; while at last follow-up, significant differentce was found only in LSA between 2 subgroups (P<0.05) . ConclusionsThe LSA should be paid more attention in surgery to assure recovery of the sagittal balance because patients with high-grade L5 isthmic spondylolisthesis have greater PI, abnormal lumbosacral kyphosis, and sagittal imbalance.
Objective To compare the effectiveness of unilateral biportal endoscopic transforaminal lumbar interbody fusion (UBE-TLIF) and endoscopic transforaminal lumbar interbody fusion (Endo-TLIF) in the treatment of single-segment degenerative lumbar spinal stenosis with lumbar spondylolisthesis. Methods Between November 2019 and May 2023, a total of 81 patients with single-segment degenerative lumbar spinal stenosis with lumbar spondylolisthesis who met the selection criteria were enrolled. They were randomly divided into UBE-TLIF group (39 cases) and Endo-TLIF group (42 cases). There was no significant difference in baseline data between the two groups (P>0.05), including gender, age, body mass index, surgical segment, and preoperative visual analogue scale (VAS) scores for low back and leg pain, Oswestry Disability Index (ODI), and serum markers including creatine kinase (CK) and C reactive protein (CRP). Total blood loss (TBL), intraoperative blood loss, hidden blood loss (HBL), postoperative drainage volume, and operation time were recorded and compared between the two groups. Serum markers (CK, CRP) levels were compared between the two groups at 1 day before operation and 1, 3, and 5 days after operation. Furthermore, the VAS scores for low back and leg pain, and ODI at 1 day before operation and 1 day, 3 months, 6 months, and 12 months after operation, and intervertebral fusion rate at 12 months after operation were compared between the two groups. Results All surgeries were completed successfully without occurrence of incision infection, vascular or nerve injury, epidural hematoma, dural tear, or postoperative paraplegia. The operation time in UBE-TLIF group was significantly shorter than that in Endo-TLIF group, but the intraoperative blood loss, TBL, and HBL in UBE-TLIF group were significantly more than those in Endo-TLIF group (P<0.05). There was no significant difference in postoperative drainage volume between the two groups (P>0.05). The levels of CK at 1 day and 3 days after operation and CRP at 1, 3, and 5 days after operation in UBE-TLIF group were slightly higher than those in the Endo-TLIF group (P<0.05), while there was no significant difference in the levels of CK and CPR between the two groups at other time points (P>0.05). All patients were followed up 12 months. VAS score of low back and leg pain and ODI at each time point after operation significantly improved when compared with those before operation in the two groups (P<0.05); there was no significant difference in VAS score of low back and leg pain and ODI between the two groups at each time point after operation (P>0.05). There was no significant difference in the intervertebral fusion rate between the two groups at 12 months after operation (P>0.05). ConclusionUBE-TLIF and Endo-TLIF are both effective methods for treating degenerative lumbar spinal stenosis with lumbar spondylolisthesis. However, compared to Endo-TLIF, UBE-TLIF requires further improvement in minimally invasive techniques to reduce tissue trauma and blood loss.
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.
Objective To review the research progress in the treatment of high-grade spondylolisthesis (HS), in order to provide a reference for clinical treatment decision-making. Methods The literature related to the treatment of HS at home and abroad in recent years was widely reviewed. The methods of conservative treatment, in situ fusion, and spondylolisthesis reduction were analyzed and summarized. Results Surgical treatment is the main treatment of HS, but which method is the best is still controversial. The advantages, disadvantages, and applicability of various operations are also different, so individualized analysis is needed in clinic. Conclusion The treatment plan of HS needs to be considered comprehensively according to the individual condition of the patient. It will be an important research direction to further compare the existing treatment methods and develop more safe and effective new technology.
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.
Objective To analyze the effectiveness of combined treatment of lumbar spondylolisthesis with MED, Quadrant, and Sextant-R systems. Methods Between August 2006 and June 2011, 35 patients with lumbar spondylolisthesis were treated, including 11 cases of isthmic spondylolisthesis and 24 cases of degenerative spondylolisthesis. There were 25 males and 10 females, with a mean age of 55 years (range, 33-71 years). The mean disease duration was 37 months (range, 8-75 months). Spondylolisthesis occurred at L4, 5 level in 21 patients and at L5, S1 level in 14 patients. According to Meyerding classification, 35 cases were rated as dergee I. The minimally invasive surgeries were performed by paraspinal muscle approach; Quadrant system was used for decompression and fusion at severe side, MED system for windowing of lamina at mild side, and Sextant-R system for fixation and reduction. Visual analogue scale (VAS) score was used to evaluate pain, Oswestry disability index (ODI) to evaluate clinical outcomes, spondylolishesis ratio and intervertebral height to evaluate spondylolisthesis reduction. Results Lumbar continuous thin layer CT at postoperation showed that no pedicle screw invaded spinal canal and intervertebral fusion device was at good position. Incisions healed by first intention. All patients were followed up 18-38 months (mean, 26 months). All patients got bone fusion and had no internal fixation failure by radiologic examination at 1 year after operation. Low back pain was relieved, lumbar function improved obviously, and satisfactory reduction of spondylolisthesis was obtained. At 2 weeks and 1 year after operation, the VAS score, ODI score, spondylolisthesis ratio, and intervertebral height were significantly improved when compared with preoperative ones (P lt; 0.05). VAS score and ODI score showed significant differences (P lt; 0.05) between at 2 weeks and 1 year after operation. Spondylolisthesis ratio and intervertebral height showed no significant difference (P gt; 0.05) between at 2 weeks and at 1 year after operation. Conclusion Minimally invasive surgical management for lumbar spondylolisthesis via MED, Quadrant, and Sextant-R systems is a safe and effective surgical technique. However, its indications should be well considered.
ObjectiveTo compare the effectiveness of unilateral biportal endoscopic decompression and unilateral biportal endoscopic lumbar interbody fusion (ULIF) in the treatment of degreeⅠdegenerative lumbar spondylolisthesis (DLS). MethodsA clinical data of 58 patients with degreeⅠDLS who met the selection criteria between October 2021 and October 2022 was retrospectively analyzed. Among them, 28 cases were treated with unilateral biportal endoscopic decompression (decompression group) and 30 cases with ULIF (ULIF group). There was no significant difference between the two groups (P>0.05) in the gender, age, lesion segment, and preoperative visual analogue scale (VAS) score of low back pain, VAS score of leg pain, Oswestry disability index (ODI), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), disk height (DH), segmental lordosis (SL), and other baseline data. The operation time, postoperative drainage volume, postoperative ambulation time, VAS score of low back pain, VAS score of leg pain, ODI, laboratory examination indexes (CRP, ESR), and imaging parameters (DH, SL) were compared between the two groups. ResultsCompared with the ULIF group, the decompression group had shorter operation time, less postoperative drainage, and earlier ambulation (P<0.05). All incisions healed by first intention, and no complication such as nerve root injury, epidural hematoma, or infection occurred. All patients were followed up 12 months. Laboratory tests showed that ESR and CRP at 3 days after operation in decompression group were not significantly different from those before operation (P>0.05), while the above indexes in ULIF group significantly increased at 3 days after operation compared to preoperative values (P<0.05). There were significant differences in the changes of ESR and CRP before and after operation between the two groups (P<0.05). Except that the VAS score of low back pain at 3 days after operation was not significantly different from that before operation in decompression group (P>0.05), there were significant differences in VAS score of low back pain and VAS score of leg pain between the two groups at other time points (P<0.05). The VAS score of low back pain in ULIF group was significantly higher than that in decompression group at 3 days after operation (P<0.05), and there was no significant difference in VAS score of low back pain and VAS score of leg pain between the two groups at other time points (P>0.05). The ODI of the two groups significantly improved after operation (P<0.05), but there was no significant difference between 3 days and 6 months after operation (P>0.05). There was no significant difference between the two groups at the two time points after operation (P<0.05). Imaging examination showed that there was no significant difference in DH and SL between pre-operation and 12 months after operation in decompression group (P>0.05). However, the above two indexes in ULIF group were significantly higher than those before operation (P<0.05). There were significant differences in the changes of DH and SL before and after operation between the two groups (P<0.05). ConclusionUnilateral biportal endoscopic decompression can achieve good effectiveness in the treatment of degree Ⅰ DLS. Compared with ULIF, it can shorten operation time, reduce postoperative drainage volume, promote early ambulation, reduce inflammatory reaction, and accelerate postoperative recovery. ULIF has more advantages in restoring intervertebral DH and SL.
Objective To analyze the therapeutic effect of the posterior pedicle screw system combined with interbody fusion cage on lumbarspondylolisthesis. Methods From February 2003 to March 2006, 37 lumbar spondylolisthesis patients were treated with this operation, including21 males and 16 females and aging 3969 years.The affected lumbars were L3(3cases)，L4(23 cases), and L5(11 cases). According to the Meyerdingevaluating system, 12 cases were lassified as degree Ⅰ, 20 cases as degree Ⅱ,and 5 cases as degree Ⅲ. Taillard index, Boxall index, slipping angle, lumbar lordosis angle and intervertebral height index were measured before operation, and 2 weeks and 3 months after operation. Results All patients were followed up 336 months. There were statistically significant differences in Taillard index, Boxall index, slipping angle, lumbar lordosis angle and intervertebral height index between before operation and 2 weeks after operation (P＜0.05),and no statistically significant differences between 2 weeks and 3 months afteroperation(P＞0.05). According to Dewei Zhou’s creterior for scoring, the results were excellent in 27 cases， good in 8 cases，and fair in 2 cases. Theexcellent and good rate was 94.6%. All of the embedded osseous were fused. Thefusing time was from 3 to 8 months (mean 3-9 months). There were no breakageof screw and rod. The position and configuration of the whole cages were good. Conclusion Applying the posterior pedicle screw system combined with interbody fusion cage may achieve synergism in the treatment of lumbar vertebral spondylolisthesis. Above procedure is served as solid internal fixationand offers a satisfactory reduction, and can improve the fusion rate of the spine. So it is an ideal procedure and worthily recommended method for treatment oflumbar vertebral spondylolisthesis.
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.
ObjectiveTo explore the effectiveness of anterior cervical plate internal fixation in the treatment of unstable Hangman fracture. MethodsBetween May 2006 and May 2010, 42 patients with unstable Hangman fracture were treated by anterior cervical plate internal fixation. There were 30 males and 12 females with an average age of 36.5 years (range, 22-64 years). According to the Levine-Edwards classification, 25 cases were rated as type Ⅱ, 15 cases as type Ⅱ A, and 2 cases as type Ⅲ. Eight patients had spinal cord injury. The average interval between injury and operation was 5 days (range, 3-14 days). The X-ray, CT, and MRI were done pre-and post-operatively to evaluate the cervical physiological curvature, the intervertebral disc height of C2,3, the fracture-healing, and bone fusion. The effectiveness was evaluated using visual analogue scale (VAS) for occipito-cervical pain, Neck Disability Index (NDI) for cervical spine function, and the Japanese Orthopaedic Association (JOA) score for neurological functional recovery. ResultsAll incisions healed by first intention. No neurological deterioration or internal fixation failure was observed. All of the patients were followed up 2-5 years (mean, 3.5 years). The complications were dysdipsia in 3 cases and dysphagia in 4 cases, which alleviated spontaneously after 1 week. All the patients were almost free from occipito-cervical pain and the limited cervical spine motion. Neurological function was improved in 8 cases of spinal cord injury, and complete decompression was observed in 6 cases who had spinal cord compression. The bone fusion was observed at 6.5 months on average (range, 6-8 months); the mean fracture-healing time was 10.5 months (range, 9-12 months). The VAS, NDI, and JOA scores were significantly improved at 3 months after operation and last follow-up when compared with preoperative scores (P<0.05), significant improvement scores were achieved at last follow-up when compared with the scores at 3 months (P<0.05). The intervertebral disc height of C2,3, the reconstructed curvature and stability of the cervical spine, and the spine movement were good. ConclusionThe method of anterior cervical plate internal fixation can achieve satisfactory reduction and fusion, less complications, negligible impact on the cervical movement. So it is an ideal method to treat unstable Hangman fracture.