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 observe the difference between crenel lateral interbody fusion (CLIF) and transforaminal lumbar interbody fusion (TLIF) in the treatment of degenerative lumbar spondylolisthesis (DLS) combined with lumbar spinal stenosis (LSS).MethodsThe clinical data of DLS combined with LSS patients meeting the selection criteria admitted between May 2018 and May 2019 were retrospectively analyzed. According to different surgical methods, the patients were divided into CLIF group (33 cases) and TLIF group (32 cases). There were no significant differences (P>0.05) between the two groups in gender, age, disease duration, lesion segments, lumbar bone mineral density, degree of lumbar spondylolisthesis, and preoperative visual analogue scale (VAS) score, Oswestry disability index (ODI), intervertebral space height, intervertebral foramen height, lumbar lordosis (LL), and segmental lordosis (SL). The operation time, intraoperative blood loss, and perioperative complications were recorded and compared between the two groups. Lumbar CT scan was performed at last follow-up to compare the intervertebral fusion rate between the two groups. Intervertebral space height, intervertebral foramen height, LL, and SL were measured before operation, at 2 weeks, 3 months after operation, and at last follow-up. VAS score and ODI were used to evaluate the pain and improvement of the quality of life of the patients.ResultsThere were no neurological and vascular complications in the two groups. The operation time and intraoperative blood loss in CLIF group were significantly less than those in TLIF group (P<0.05). Patients in both groups were followed up for a median time of 18 months. All the incisions healed by first intention except 1 incision in TLIF group because of poor blood glucose control. No complications such as bedsore, falling pneumonia, and deep venous thrombosis were found in both groups. At last follow-up, the intervertebral fusion rates in CLIF and TLIF group were 90.91% (30/33) and 93.75% (30/32), respectively, showing no significant difference (χ2=0.185, P=0.667). The VAS score, ODI, intervertebral space height, intervertebral foramen height, LL, and SL were significantly improved in both groups at each time point after operation (P<0.05). Except that VAS score in CLIF group was significantly lower than that in TLIF group at 2 weeks after operation (Z=−4.303, P=0.000), there were no significant differences in VAS score and ODI between the two groups at other time points (P>0.05). The intervertebral space height, intervertebral foramen height, LL, and SL in CLIF group were significantly higher than those in TLIF group at each time point after operation, and the differences were significant (P<0.05).ConclusionCLIF in the treatment of DLS combined with LSS can achieve the similar effectiveness with traditional TLIF, and has such advantages as minimal invasion and faster recovery.
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.
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 modified direction-changeable lumbar Cage in transforaminal lumbar interbody fusion (TLIF).MethodsA retrospective analysis was made of 161 patients with single segment L4 or L5 isthmic spondylolisthesis treated between January 2013 and December 2015. According to the implantation of Cage, they were divided into trial group (85 cases, modified direction-changeable lumbar Cage implanted in TLIF) and control group (76 cases, traditional nondirection-changeable Cage implanted in TLIF). There was no significant difference in the general data of gender, age, disease duration, slippage segment, and slippage grade between the two groups (P>0.05). The intraoperative implantation time of Cage, Cage position adjustments times, fluoroscopy times during implantation of Cage, fluoroscopy exposure time, and total operation time were recorded and compared between the two groups. Visual analogue scale (VAS) and Oswestry disability index (ODI) scores were used to evaluate the effectiveness of the patients before operation, and at 3, 6, and 12 months after operation, and the incidence of complications was recorded and analyzed. CT examinations were performed at 6 and 12 months after operation, and lumbar fusion was evaluated by Bridwell criteria.ResultsThe intraoperative implantation time of Cage, Cage position adjustments times, fluoroscopy times during implantation of Cage, fluoroscopy exposure time, and total operation time in trial group were significant less than those in control group (P<0.05). All the 161 patients were followed up 12-18 months (mean, 14.3 months). There was 1 case of dural sac tear in the trial group and 1 case of superficial infection in the control group; no complication such as dural tear and infection occurred in other patients. The fusion rate was 76.5% (64/85) in the trial group and 57.9% (44/76) in the control group at 6 months after operation, showing significant difference (χ2=6.44, P=0.02); at 12 months after operation, the fusion rate was 96.5% (82/85) in the trial group and 90.8% (69/76) in the control group (including 3 cases of Cage displacement and 4 cases of screw breakage), showing no significant difference in the fusion rate between the two groups (χ2=1.54, P=0.26). The VAS and ODI scores of the two groups decreased gradually at 3, 6, and 12 months after operation, and improved significantly when compared with those before operation (P<0.05). There was no significant difference in VAS and ODI scores between the two groups before and after operation (P>0.05).ConclusionBoth Cages can obtain the similar effectiveness. The modified direction-changeable lumbar Cage can significantly reduce the fluoroscopy times and radiation dose during TLIF, shorten the operation time, and effectively reduce the radiation exposure of patients and medical staff.
Objective To study the relationship between sagittal facet joint and degenerative lumber spondylolisthesis (DLS) by observing the changes of the lumbar facet joint angle. Methods Fifty-seven patients with DLS who met the inclusion criteria between January 2013 and February 2016 were collected (DLS group). There were 26 males and 31 females, with the mean age of 54.0 years (range, 34-84 years). Forty patients without DLS at same stage were collected as control group. There were 23 males and 17 females with the mean age of 55.6 years (range, 29-82 years). There was no significant difference in gender and age between 2 groups (P>0.05). The lumbar facet joint angles were measured and compared by MRI scanning images in 2 groups. In DLS group, X-ray films were used to evaluated the degree of the lumbar spondylolisthesis on the basis of the Meyerding standard, and compared the facet joint angles between patients of different DLS degree. Results Facet joint angles in the DLS group [(34.18± 4.81)°] were significantly smaller than those in control group [(45.87±1.09)°] (t=15.073, P=0.000). In DLS group, the patients were rated as degree Ⅰ in 24 cases, degree Ⅱ in 19 cases, degree Ⅲ in 14 cases. As the degree of DLS increased, the lumbar joint angle decreased gradually, and showing significantly differences between patients of different DLS degree (P<0.05). Conclusion Sagittal lumbar facet joint may be one of the main risk factors of DLS.
ObjectiveTo review the researches of the role of the facet joint orientation (FJO) in degenerative spondylolisthesis (DS). MethodsRelated literature concerning the FJO in patients with DS was extensively reviewed and comprehensively analyzed in 4 terms of the basic concepts, measurement methods, the controversial etiology, and the clinical significance. ResultsThe multiplanar reformation of spiral CT is expected to become a new method of studying the FJO. The causal relationship between the sagittal FJO and DS is still controversial, but further prospective studies are needed to resolve this issue. The sagittal FJO is very important in the prevention of DS and the choice of surgery plan. ConclusionThe etiologic relationship between the FJO and DS need to be further studied.