Objective To evaluate the effect of posterior lumbar interbody fusion (PLIF) using single incision via MAST Quadrant retractor in the management of lumbar spondylolisthesis. Methods From July 2008 to June 2009, 20 cases of lumbar spondylolisthesis were treated with posterior lumbar interbody fusion via MAST Quadrant retractor using single incision,including 2 cases of degenerative spondylolisthesis and 18 cases of isthmic spondylolisthesis. There were 8 males and 12 females aged from 34 to 62 years (average 45.5 years). The disease course was 1 to 6 years (mean 34.5 months). The spondylol isthesis locations were L4,5 in 8 cases and L5, S1 in 12 cases. According to Meyerding classification, all cases were classified as degree I. The Visual Analogue Scale (VAS) score was (6.6 ± 1.2) points. The operative time, the blood loss, and the therapeutic effects were recorded. Results The operative time was (155 ± 23) minutes and the amount of blood loss was (360 ± 102) mL. The hospitalization time were (12.0 ± 3.4) days. All incisions healed by first intention. X-ray films showed spondylolisthesis reduction immediately after operation. All patients were followed up 14.3 months on average (from 9 to 20 months). The VAS score decreased to (1.6 ± 2.3) points at the last follow-up, showing significant difference when compared with that of preoperation (P lt; 0.05). The X-ray films showed that lumbar interbody fusion was achieved in all the patients. No lossening, breakage, and displacement of pedicle screw fixation was observed. According to Nakai standard, the results were excellent in 18 cases and good in 2 cases at the last follow-up. Conclusion As long as the indication is strictly chosen, PLIF via MAST Quadrant retractor is a safe, effective, and minimally invasive surgical technique in treating lumbar spondylolisthesis.
Objective To evaluate the therapeutic effects of expandable pedicle screw (EPS) combined with interbody fusion cage on lumbar spondylolisthesis. Methods From June 2004 to March 2008, 23 patients with lumbar spondylolisthesiswere treated, including 9 males and 14 females aged 24-72 years old (average 48.7 years old). The course of the disease varied from 6 months to 6 years (average 30.4 months). There were 18 cases of degenerative spondylol isthesis and 5 of isthmic spondylolisthesis, including 1 case at L3,4 level, 14 at L4,5 level, and 8 at L5 and S1 levels. There were 17 cases of grade I, 4 of grade II, and 2 of grade III (including 1 case of recurrent L5 spondylolysis) according to Meyerding classification system. Posterior lumbar interbody fusion was performed using 48 PLIVIOS interbody fusion cages, and spondylolisthesis reduction and internal fixation were conducted using 84 pieces of EPS. The indications for use of EPS were initial operation with bone mass reduction or osteoporosis, reoperation of previous pedicle instrumentation, intraoperative screw relocation, sacral anchoring, and construct reinforcement. Cl inical outcomes, radiographic reduction of spondylol isthesis and bone fusion of lumbar interbody were evaluated based on JOA score, Boxall index, and Cook criteria. Results The incision healed by first intension in all cases except for one revision case that suffered from postoperative cerebrospinal fluid leakage and obtained delayed-healing without infection 23 days after operation using conservative treatment. No operative compl ications such as nerve and organ injuries were found.All cases were followed up for 12-39 months (average 17.8 months). X-ray exams of spine AP, lateral, fully extended position and fully flexed position view showed all 84 EPS were fully expanded within vertebral body. The improvement rate of JOA at the final follow-up visit was markedly effective in 14 cases, and effective in 5 cases, and noneffective in 4 cases, with a total effective rate of 82.61%. Anatomic reduction was achieved in 14 cases, improvement was obtained in 6 cases, no improvement was observed in 3 cases, and the reduction rate was 86.69%. Lumber interbody fusion was achieved in 20 cases, fixation was achieved in 2 cases, failure was observed in 1 cases, and the fusion rate was 86.69%. Conclusion EPS in complex with interbody fusion cage provides effective reduction, internal fixation and interbody fusion for the reconstruction of lumbar spondylolisthesis.
Objective To investigate the cl inical outcomes of lumbar spondylol isthesis associated with lumbar spinal stenosis through decompressive laminectomy, spondylol ithesis reduction system (SRS) internal fixation, single posteriolateralVigor Spacer threaded fusion cages and intertransverse process arthrodesis bone grafting. Methods From June 2002 to June 2006, 58 cases of lumbar spondylol isthesis were treated with decompressive laminectomy, fixed by SRS instrumentation, posterior installed with interbody Vigor Spacer Cage and bone grafted between intertransverse process arthrodesis. There were 47 males and 11 females, aged 32-66 years old (45.8 on average). The course of disease was 3 months to 7 years, with an medium course of 25 months. Accoding to the Meyerding standard, 38 cases were classified as degree I and 20 as degree II. Spondylol isthesis between L4 and L5 covered 21 cases and between L5 and S1 covered 37 cases. There were 44 cases of lumbar spondylol isthesis and 14 of degenerative lumbar spondylol isthesis. The intervertebral height was 1.5-10.5 mm with the average of 5.1 mm. Results All patients’ incisions obtained heal ing by first intension after operation. The operation time was 50-90 minutes with an average of 65 minutes. The blood loss was 200-500 mL with an average of 250 mL. The patients were followed up for 10-38 months with an average of 23.6 months. According to the Macrab criteria, 54 cases were excellent, 3 good, 1 fair and the choiceness rate was 98.3%. According to the Meyerding classification, 38 cases of degree I and 19 out of 20 cases of degree II obtained complete reduction, and the rate of complete reduction was 98.3%. There were 57 (98.3%) cases which fused well 3-6 months after operation. The intervertebral height resumed to 9.6-12.5 mm with an average of 11.6 mm, and no intervertebral height loss was found. Conclusion The treatment of lumbar spondylol isthesis with decompressive laminectomy, SRS internal fixation, single posteriorolateral Vigor Spacer threaded fusion cage and bone grafting has excellent cl inical results and stable reduction.
ObjectiveTo evaluate the effectiveness of transforaminal lumbar interbody fusion (TLIF) via Luxor retractor associated with Mantis pedicle screw for the treatment of moderate or severe lumbar spondylol isthesis (LSL). MethodsA retrospective analysis was made on the cl inical data of 32 patients with LSL treated with TLIF via Luxor retractor associated with Mantis pedicle screw between June 2010 and June 2012. There were 20 males and 12 females, with the mean age of 48 years (range, 36-69 years). LSL occurred at the L4, 5 in 17 patients and at the L5, S1 in 15 patients. Of them, 18 cases were rated as Meyerding grade Ⅱ, and 14 cases as grade Ⅲ. The disease duration was 8 months to 6 years (mean, 3.5 years). The operation time, intraoperative blood loss, and preoperative and postoperative (1 week and 1 year) intervertebral height and sl ipping angle were recorded, and the sl ipping rate was calculated; Japanese Orthopaedic Association (JOA) score was used for cl inical efficacy assessment. ResultsThe operation time was 90-130 minutes (mean, 110 minutes); intraoperative blood loss was 120-300 mL (mean, 210 mL). Incisions healed by first intention. All patients were followed up 24-36 months (mean, 28 months), and no complications of leakage of cerebrospinal fluid and nerve root injury occurred; X-ray films showed satisfactory reduction of spondylolisthesis and good position of pedicle screw and interbody fusion cage. The mean bone fusion time was 4.0 months (range, 3.8-6.0 months). The JOA score, sl i pping rate, sl i pping angle, and intervertebral height at 1 week and 1 year after operation were significantly improved when compared with preoperative ones (P<0.05), but no significant difference was found between at 1 week and at 1 year after operation (P>0.05). ConclusionTLIF via Luxor retractor associated with Mantis pedicle screw fixation is a safe and effective minimally invasive technique in treating moderate or severe LSL.