Abstract
ObjectiveTo compare the radiographic parameters and clinical outcomes of isthmic L5–S1 spondylolisthesis with single segment or two-segment pedicle screw fixation.MethodsBetween January 2018 and January 2019, a total of 76 patients with isthmic L5–S1 spondylolisthesis were included in this study. All patients were treated with varying numbers of pedicle screw fixation with single-segment fusion during posterior lumbar interbody fusion (PLIF). Patients were divided into two groups, based on the number of pedicle screws placed during fixation, namely, 4 screws (4S) group and 6 screws (6S) group. Subsequently, the sagittal balance parameters were measured, which included slippage degree (SD), lumbar lordosis (LL), segmental lordosis (SL), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), and sagittal vertical axis (SVA). Clinical functional outcomes were assessed using the visual analog scale (VAS) for back pain and the oswestry disability index (ODI) scores.ResultsThe 4S group comprised of 10 males and 27 females, with a median age of 55.2 ± 10.8 years old and a mean follow-up of 16.95 ± 4.16 months. The 6S group comprised of 14 males and 25 females, with a median age of 58.1 ± 7.5 years old and a median follow-up of 17.33 ± 3.81 months. No significant differences were evident in all preoperative parameters between both groups. In contrast, the postoperative LL, SL, PT, SS, and SD values increased significantly, compared to the preoperative values in both groups (all P < 0.05). At the last follow-up, the 6S group exhibited better correction in LL, SL, and PT, relative to the 4S group (all P < 0.05). A significant SD difference was observed between both groups at all points post surgery (P < 0.05). The postoperative slip correction rate was significantly larger in the 6S group, compared to the 4S group (P < 0.05). The postoperative VAS and ODI scores of both groups improved significantly, when compared to the preoperative scores (both P < 0.05). However, there were no significant differences in the ODI and VAS scores between the two groups at all time points.ConclusionsThe clinical outcomes of both approaches appeared to be satisfactory. In terms of short-term outcomes, the 6S group exhibited better spinal sagittal restoration and stability than the 4S group.
Highlights
Isthmic spondylolisthesis is a common spinal disease that results from a pars interarticular defect and the L5–S1 region is the most commonly affected region
Inclusion and exclusion criteria The inclusion criteria were as follows: (1) patients with L5-S1 isthmic spondylolisthesis; (2) patients experiencing symptoms of unilateral/double sciatica or intermittent claudication, with low back pain, who are unresponsive to conservative therapy for over 6 months; (3) patients treated with varying numbers of pedicle screws during the L5–S1 fusion Posterior lumbar interbody fusion (PLIF) surgery; (4) Patient followup duration of more than 1 year
Demographic The 4 screws (4S) group consisted of 10 males and 27 females, with a mean age of 55.2 ± 10.8 years old
Summary
Isthmic spondylolisthesis is a common spinal disease that results from a pars interarticular defect and the L5–S1 region is the most commonly affected region. Lumbar spondylolisthesis manifestations are related to lumbar spinal stenosis, which produces symptomatic compression of the neural element. It can surface due to segmental instability. This condition is initially treated with conservative management strategies. Surgical intervention can effectively relieve dural sac and nerve root compression, prevent spondylolisthesis degeneration from aggravation, correct spinal deformity, and stabilize the lumbar spine [1]. Posterior lumbar interbody fusion (PLIF) is a widely used surgical approach for treating lumbar spondylolisthesis. Pedicle screw placement is crucial to the success of PLIF-based fusion, and has shown remarkable clinical outcomes [2, 3]
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