COMPARATIVE STUDY ON TWO SURGICAL TREATMENT OF ISTHMIC SPONDYLOLISTHESIS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANGChao ^1,2 ,  SUNTianwei ² , TIANRong ² , JIAYutao ² , XUTiantong ² , SHENQingfeng ²

1. Graduate School of Tianjin Medical University, Tianjin, 300070, P. R. China;
2. Department of Spine Surgery, Tianjin Union Medicine Center;

Corresponding author：

SUNTianwei, Email: billsuntw@163.com

Keywords：

Isthmic spondylolisthesis; Internal fixation; Lumbar interbody fusion; Posterolateral fusion

DOI：

10.7507/1002-1892.20150039

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Objective To compare the effectiveness of treatment of isthmic spondylolisthesis between two different fusion surgeries combined with pedicle screw fixation system. Methods A retrospectively analysis was made on the clinical data of 98 patients with lumbar isthmic spondylolisthesis treated between February 2009 and May 2012. Of 98 cases, 53 underwent posterior lumbar interbody fusion (PLIF) combined with internal fixation (group A), and 45 underwent posterolateral fusion (PLF) with internal fixation (group B). There was no significant difference in gender, age, disease duration, segmental lesions, and degree of spondylolisthesis between 2 groups (P>0.05). The operation time, intraoperative blood loss, reduction rate of spondylolisthesis, reduction loss rate, fusion rate, intervertebral space height, Japanese Orthopedic Association (JOA) score, and the recovery rate of JOA score were compared between 2 groups. Results The operation time and intraoperative blood loss of group A were significantly higher than those of group B (P<0.05). Dural tear occured in 4 cases of group A and 1 case of group B during operation; 6 cases had radicular symptoms after operation in group A; incision infection was found in 1 case of 2 groups respectively. The follow-up time was 24-36 months in group A and was 26-40 months in group B. No significant difference was found in the JOA score at preoperation and 2 weeks after operation between 2 groups (P>0.05). The JOA score and the recovery rate of JOA score of group A were significantly better than those of group B at 2 years after operation (P<0.05). X-ray film showed that the reduction rate of group A was significantly higher than that of group B after 2 weeks of operation (P<0.05); the reduction loss rate of group A was significantly lower than that of group B after 2 years after operation (P<0.05). The intervertebral space height of group A was significantly higher than that of group B at 2 weeks and 2 years after operation (P<0.05). The fusion rate of group A was significantly better than that of group B at 2 years after operation (P<0.05). Conclusion PLIF can achieve a greater degree of reduction, better restore disc height, and lumbar curvature than PLF. PLIF is superior to PLF in maintaining intervertebral height after operation. And PLIF has higher fusion rate, restores the stability of the spine in a greater extent, and it also can achieve a better long-term outcome.

Citation： ZHANGChao, SUNTianwei, TIANRong, JIAYutao, XUTiantong, SHENQingfeng. COMPARATIVE STUDY ON TWO SURGICAL TREATMENT OF ISTHMIC SPONDYLOLISTHESIS. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(2): 179-183. doi: 10.7507/1002-1892.20150039 Copy

1.	Leone A, Cianfoni A, Cerase A, et al. Lumbar spondylolysis:a review. Skeletal Radiol, 2011, 40(6):683-700.
2.	Meyerding HW. Spondylolisthesis. Surg Gynecol Obstet, 1932, 54:371-377.
3.	Shirado O, Doi T, Akai M, et al. An outcome measure for Japanese people with chronic low back pain:an introduction and validation study of Japan Low Back Pain Evaluation Questionnaire. Spine (Phila Pa 1976), 2007, 32(26):3052-3059.
4.	陈崇文, 佟斌, 陈志勇, 等. 退变性和峡部裂性腰椎滑脱症的治疗及比较. 中国矫形外科杂志, 2011, 19(15):1241-1243.
5.	Taillard WF. Etiology of spondylolisthesis. Clin Orthop Relat Res, 1976, (117):30-39.
6.	Suk SI, Lee CK, Kim WJ, et al. Adding posterior lumbar interbody fusion to pedicle screw fixation and posterolateral fusion after decompression in spondylolytic spondylolisthesis. Spine (Phila Pa 1976), 1997, 22(2):210-219.
7.	Kalichman L, Kim DH, Li L, 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.
8.	Lundin DA, Wiseman D, Ellenbogen RG, et al. Direct repair of the pars interarticularis for spondylolysis and spondylolisthesis. Pediatr Neurosurg, 2003, 39(4):195-200.
9.	邹德威, 欧阳甲, 阮狄克, 等. 关于腰椎滑脱治疗中一些问题的讨论. 中国脊柱脊髓杂志, 2006, 16 (1):7-10.
10.	徐杰, 刘春华, 黄惠梅, 等. 后路单枚Cage植骨融合联合椎弓根钉棒系统治疗腰椎滑脱症. 中国修复重建外科杂志, 2012, 26(7):891-892.
11.	DeWald CJ, Vartabedian JE, Rodts MF, et al. Evaluation and management of high-grade spondylolisthesis in adults. Spine (Phila Pa 1976), 2005, 30(6 Suppl):S49-59.
12.	Spruit M, Pavlov PW, Leitao J, et al. Posterior reduction and anterior lumbar interbody fusion in symptomatic low-grade adult isthmic spondylolisthesis:short-term radiological and functional outcome. Eur Spine J, 2002, 11(5):428-433.
13.	Hsieh PC, Koski TR, O'Shaughnessy BA, et al. Anterior lumbar interbody fusion in comparison with transforaminal lumbar interbody fusion:implications for the restoration of foraminal height, local disc angle, lumbar lordosis, and sagittal balance. J Neurosurg Spine, 2007, 7(4):379-386.
14.	Evans JH. Biomechanics of lumbar fusion. Clin Orthop Relat Res, 1985, (193):38-46.
15.	Robert Gunzburg, Marek Szpalski. Spondylolysis, Spondylilisthesis, and Degenerative Spondylolisthesis. Philadephia:Lippincott Williams&Willins, 2006:118.
16.	Kwon DW, Kim KH, Park JY, et al. Clinical outcomes and considerations of the lumbar interbody fusion technique for lumbar disk disease in adolescents. Childs Nerv Syst, 2013, 29(8):1339-1344.
17.	Ekman P, Möller H, Tullberg T, et al. Posterior lumbar interbody fusion versus posterolateral fusion in adult isthmic spondylolisthesis. Spine (Phila Pa 1976), 2007, 32(20):2178-2183.
18.	郝定均, 温世明, 窦榆生. 椎间融合器与椎弓根钉固定治疗腰椎滑脱症的比较研究. 中国骨与关节损伤杂志, 2005, 20(3):145-147.
19.	陈亮, 唐天驷, 杨惠林, 等. 后路BAK椎间融合术治疗腰椎滑脱症的并发症分析. 中华骨科杂志, 2002, 22(6):337-339, 342.

1. Leone A, Cianfoni A, Cerase A, et al. Lumbar spondylolysis:a review. Skeletal Radiol, 2011, 40(6):683-700.
2. Meyerding HW. Spondylolisthesis. Surg Gynecol Obstet, 1932, 54:371-377.
3. Shirado O, Doi T, Akai M, et al. An outcome measure for Japanese people with chronic low back pain:an introduction and validation study of Japan Low Back Pain Evaluation Questionnaire. Spine (Phila Pa 1976), 2007, 32(26):3052-3059.
4. 陈崇文, 佟斌, 陈志勇, 等. 退变性和峡部裂性腰椎滑脱症的治疗及比较. 中国矫形外科杂志, 2011, 19(15):1241-1243.
5. Taillard WF. Etiology of spondylolisthesis. Clin Orthop Relat Res, 1976, (117):30-39.
6. Suk SI, Lee CK, Kim WJ, et al. Adding posterior lumbar interbody fusion to pedicle screw fixation and posterolateral fusion after decompression in spondylolytic spondylolisthesis. Spine (Phila Pa 1976), 1997, 22(2):210-219.
7. Kalichman L, Kim DH, Li L, 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.
8. Lundin DA, Wiseman D, Ellenbogen RG, et al. Direct repair of the pars interarticularis for spondylolysis and spondylolisthesis. Pediatr Neurosurg, 2003, 39(4):195-200.
9. 邹德威, 欧阳甲, 阮狄克, 等. 关于腰椎滑脱治疗中一些问题的讨论. 中国脊柱脊髓杂志, 2006, 16 (1):7-10.
10. 徐杰, 刘春华, 黄惠梅, 等. 后路单枚Cage植骨融合联合椎弓根钉棒系统治疗腰椎滑脱症. 中国修复重建外科杂志, 2012, 26(7):891-892.
11. DeWald CJ, Vartabedian JE, Rodts MF, et al. Evaluation and management of high-grade spondylolisthesis in adults. Spine (Phila Pa 1976), 2005, 30(6 Suppl):S49-59.
12. Spruit M, Pavlov PW, Leitao J, et al. Posterior reduction and anterior lumbar interbody fusion in symptomatic low-grade adult isthmic spondylolisthesis:short-term radiological and functional outcome. Eur Spine J, 2002, 11(5):428-433.
13. Hsieh PC, Koski TR, O'Shaughnessy BA, et al. Anterior lumbar interbody fusion in comparison with transforaminal lumbar interbody fusion:implications for the restoration of foraminal height, local disc angle, lumbar lordosis, and sagittal balance. J Neurosurg Spine, 2007, 7(4):379-386.
14. Evans JH. Biomechanics of lumbar fusion. Clin Orthop Relat Res, 1985, (193):38-46.
15. Robert Gunzburg, Marek Szpalski. Spondylolysis, Spondylilisthesis, and Degenerative Spondylolisthesis. Philadephia:Lippincott Williams&Willins, 2006:118.
16. Kwon DW, Kim KH, Park JY, et al. Clinical outcomes and considerations of the lumbar interbody fusion technique for lumbar disk disease in adolescents. Childs Nerv Syst, 2013, 29(8):1339-1344.
17. Ekman P, Möller H, Tullberg T, et al. Posterior lumbar interbody fusion versus posterolateral fusion in adult isthmic spondylolisthesis. Spine (Phila Pa 1976), 2007, 32(20):2178-2183.
18. 郝定均, 温世明, 窦榆生. 椎间融合器与椎弓根钉固定治疗腰椎滑脱症的比较研究. 中国骨与关节损伤杂志, 2005, 20(3):145-147.
19. 陈亮, 唐天驷, 杨惠林, 等. 后路BAK椎间融合术治疗腰椎滑脱症的并发症分析. 中华骨科杂志, 2002, 22(6):337-339, 342.

Chinese Journal of Reparative and Reconstructive Surgery

COMPARATIVE STUDY ON TWO SURGICAL TREATMENT OF ISTHMIC SPONDYLOLISTHESIS

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