Abstract
BackgroundFew reports to date have evaluated the effects of different pedicle screw insertion depths on sagittal balance and prognosis after posterior lumbar interbody and fusion (PLIF) in patients with lumbar degenerative spondylolisthesis (LDS).MethodsA total of 88 patients with single-level PLIF for LDS from January 2018 to December 2019 were enrolled. Long screw group (Group L): 52 patients underwent long pedicle screw fixation (the leading edge of the screw exceeded 80% of the anteroposterior diameter of vertebral body). Short screw group (Group S): 36 patients underwent short pedicle screw fixation (the leading edge of the screw was less than 60% of the anteroposterior diameter of vertebral body). Local deformity parameters of spondylolisthesis including slip degree (SD) and segment lordosis (SL), spino-pelvic sagittal plane parameters including pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS) and lumbar lordosis (LL), Oswestry Disability Index (ODI), and Visual Analog Scale (VAS) for back pain of both groups were compared. Postoperative complications, including vertebral fusion rate and screw loosening rate, were recorded.ResultsExcept that PI in Group S at the final follow-up was not statistically different from the preoperative value (P > 0.05), other parameters were significantly improved compared with preoperative values one month after surgery and at the final follow-up (P < 0.05). There was no significant difference in parameters between Group L and Group S before and one month after surgery (P > 0.05). At the final follow-up, SD, SL, LL, PT and PI-LL differed significantly between the two groups (P < 0.05). Compared with the preoperative results, ODI and VAS in both groups decreased significantly one month after surgery and at the final follow-up (P < 0.05). Significant differences of ODI and VAS were found between the two groups at the final follow-up (P < 0.05). Postoperative complications were not statistically significant between the two groups (P > 0.05).ConclusionsPLIF can significantly improve the prognosis of patients with LDS. In terms of outcomes with an average follow-up time of 2 years, the deeper the screw depth is within the safe range, the better the spino-pelvic sagittal balance may be restored and the better the quality of life may be.
Highlights
Few reports to date have evaluated the effects of different pedicle screw insertion depths on sagittal balance and prognosis after posterior lumbar interbody and fusion (PLIF) in patients with lumbar degenerative spon‐ dylolisthesis (LDS)
Through clinical treatments in recent years, we have found that the depth of pedicle screw insertion into the vertebral body in PLIF generally accounts for more than half of the anterior and posterior diameter of the vertebral body, and the longest depth even reaches the anterior wall of the vertebral body
52 patients were divided into long screw group (Group L) because the anterior edge of screws were more than 80% of the anteroposterior diameter of vertebral body, and 36 patients were divided into short screw group (Group S) because the anterior edge of screws were less than 60% of the anteroposterior diameter of vertebral body
Summary
Few reports to date have evaluated the effects of different pedicle screw insertion depths on sagittal balance and prognosis after posterior lumbar interbody and fusion (PLIF) in patients with lumbar degenerative spon‐ dylolisthesis (LDS). Primary dehydration of intervertebral discs and the resulting reduction of the intervertebral space usually develop motor segment lowering, ligament slackening, annulus fibrosus protrusion, and ligament wrinkling and hypertrophy, which lead to lumbar degenerative diseases, such as lumbar disc herniation, lumbar spinal canal stenosis, lumbar spondylolisthesis [2, 3]. Lumbar degenerative spondylolisthesis (LDS) with the clinical manifestation of low back pain, sciatica, and neurogenic claudication, which often need decompression and fusion surgery to deal with the herniated disc and unstable alignment, in order to enlarge canal area, release the nerve root and improve the biomechanical condition. Since posterior lumbar interbody and fusion (PLIF) was reported by Cloward in 1943 [4], this procedure has performed widely all over the word along with the development of electrocoagulation, pedicle screw and interbody fusion cage.
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