Surgical Results of Posterior Lumbar Interbody Fusion with Transpedicular Fixation in Management of Spondylolisthesis

Ahmed Taha,Mohamed Youssef

doi:10.4236/ojmn.2020.101015

Abstract

Objective: To evaluate the surgical results of posterior lumber interbody fusion with transpedicular fixation with rod screw system in management of spondylolisthesis. Study Design: Retrospective study reviewed all patient treated by lumber interbody fusion with transpedicular fixation with rod screw system. Patients and Methods: They were 40 patients operated for lumber and lumbosacral spondylolisthesis from Feb 2014 to April 2017 in Al-Azhar university hospital. These patients followed postoperatively clinically for improved neural function and for fusion stability and hardware fixation by radiological investigation. Data about pain intensity (by Visual Analogue Scale) was collected pre- and postoperatively; and outcome was assessed by Oswetry disability index (ODI). Outcome was graded as excellent, good, fair, or poor. Pre- and Post-operative data were statistically compared. Results: The mean age was 45 years (range between 30 - 60 years) with female sex predominance (male:female = 1:3). They had lytic (n = 30) or degenerative (n = 10) spondylolisthesis; and all underwent PLIF (posterior lumbar interbody fusion). In lytic group, the level was L4/L5 in 19 patients and L5/S1 in 11 patients, while in degenerative group the level was L4/L5 in 4 patients, L5/S1 in 3 patients, L2/L3 in 2 and L3/L4 in one patient. The spondylolisthesis grade was grade I among 25 subjects, grade two among 11 subjects and retrolisthesis among 4 subjects. Sensory deficits reported in 22 subjects (19 had lytic and 3 had degenerative spondylolisthesis); while motor deficits reported among 10 subjects and reduced reflexes among 8 subjects. The outcome was excellent, good, and fair among 30, 7, and 3 subjects respectively. The return to previous levels of activity was reported among 32 patients. VAS was 3.5 ± 2.94 at the end of follow up, while ODI was 28% and 36.0% and 3 and 6 months respectively. Conclusion: PLIF associated with transpedicular rod screw fixation system for management of spondylolisthesis is considered a safe and effective surgical intervention in both lytic and degenerative types.

Highlights

Spondylolisthesis is defined as the “subluxation of a vertebral body over another in the sagittal plane”
Study Design: Retrospective study reviewed all patient treated by lumber interbody fusion with transpedicular fixation with rod screw system
Sensory deficits reported in 22 subjects (19 had lytic and 3 had degenerative spondylolisthesis); while motor deficits reported among 10 subjects and reduced reflexes among 8 subjects

Summary

Introduction

Spondylolisthesis is defined as the “subluxation of a vertebral body over another in the sagittal plane”. It is a frequent mechanism responsible for intervertebral instability [1] [2]. Indications of surgical treatment of spondylolisthesis included claudication of neurogenic origin, severe radicular pain, intractable low back pain, instability, neurological manifestations, failure of medical treatment, progressive course, grades III and IV of listhesis and spondyloptosis [2] [4] [5]. The Meyerding’s classification [7] aims to assess severity of disease using lateral radiographs to judge the potential anterior displacement of the cephalad vertebral body over its distal counterpart

Methods

Results

Discussion

Conclusion