Degenerative Lumbar Spondylolisthesis Patients Research Articles

Long-Term Outcomes Following Lumbar Microendoscopic Decompression for Lumbar Spinal Stenosis with and without Degenerative Spondylolisthesis: Minimum 10-Year Follow-Up

To determine whether preoperative presence of degenerative lumbar spondylolisthesis (DS) worsens the minimum 10-year outcome of patients undergoing microendoscopic decompression (MED) for lumbar spinal stenosis (SS). Eighty patients undergoing MED were classified into 2 groups: DS group (34 SS with DS patients) and SS group (46 SS without DS patients). The degrees of improvement (DOIs) by the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) and intensities of improvement (IOIs) by Visual Analog Scale (VAS) at 120-159 (mean, 138.4) months after MED of the DS and SS groups were statistically compared. Patients with DS were classified into 2 groups based on the effectiveness by VAS or JOABPEQ: effective group (E group: IOI or DOI ≥20) and ineffective group (I group). All preoperative radiologic measurements were statistically compared between the E and I groups. Significant decreases in low back pain, leg pain, and numbness, as measured by VAS, were noted at follow-up in the DS and SS groups. The effectiveness rates of pain-related disorders, lumbar spine dysfunction, and gait disturbance by JOABPEQ were almost equally high in the DS and SS groups. Statistical comparisons of the DOIs in all 5 functional scores and IOIs in low back pain, leg pain, and numbness showed no significant differences between the DS and SS groups. No significant differences were confirmed between the E and I groups concerning preoperative spondylolisthesis and instability. Our study indicated that preoperative DS did not worsen the outcome of patients with SS undergoing MED.

Analysis of characteristics of lumbar spine-pelvic structural parameters in degenerative lumbar spondylolisthesis

To analyze the characteristics of lumbar spine-pelvic structure in degenerative lumbar spondylolisthesis and its significance in degenerative lumbar spondylolisthesis(DLS). The clinical data of 45 patients with simple degenerative L4, 5-segment lumbar spondylolisthesis (spondylolisthesis group) admitted from April 2015 to January 2017 were retrospectively analyzed, which were compared with 50 healthy people with complete physical examination data in the same period(control group). Statistical analysis of the lumbar spine-pelvic structure parameters of the subjects through imaging data was performed to analyze the characteristics of the spine-pelvis of DLS patients. The degenerative characteristicsof intervertebral disc and articular process joint were observed in degenerative lumbar spondylolisthesis. Use Spearson to analyze the correlation between observation items. The facet joint angle, lumbar lordosis angle (LL), pelvic incidence angle(PI), pelvic tilt angle (PT), sacral slope angle (SS) in spondylolisthesis group of L4, 5-segment were (36.5±11.2)°, (44.2±7.3)°, (66.5±11.6)°, ( 22.2±10.0)°, (33.4±11.3)°, respectively, while in control group were (44.4±8.2)°, (36.7±8.5)°, (55.4± 13.2)°, (14.4±7.0)°, (42.3±13.1)°. PI, LL, PT of spondylolisthesis group were obviously larger than that of control group (P< 0.05), the facet joint angle and SS of spondylolisthesis group were smaller than that of control group(P<0.05). The correlation analysis showed that PI value was related to the PT and SS in two group. The degree of degeneration of intervertebral disc was related to the degree of spondylolisthesis. The degree of degeneration of L3-S1 intervertebral disc and L4, 5 facet jointin spondylolisthesis group was more serious (P <0.05). Lumbar spinal pelvic structure of degenerative lumbar spondylolisthesis has undergone significant changes. Lumbar lordosis and pelvic dumping phenomenon in the mechanism of lumbar degeneration plays an important role. Lumbar facet joint degeneration and lumbar intervertebral disc degeneration are mutually promoted, and lumbar spondylolisthesis aggravates intervertebral disc and facet joint degeneration.

203. The effect of surgical decompression and fusion on functional balance in patients with degenerative lumbar spondylolisthesis

BACKGROUND CONTEXT Degenerative lumbar spondylolisthesis (DLS) is a condition in which one vertebra subluxates relative to an adjacent vertebra in the absence of a disruption in the neural arch. While the existing literature demonstrates that decompression and fusion can successfully alleviate pain and reduce disability in patients with DLS, no studies to date have used quantitative dynamic testing to determine the effect of surgery on cone of economy (CoE) measures in this patient population. PURPOSE To quantify the effect of lumbar decompression and fusion surgery on balance and stability in patients with degenerative lumbar spondylolisthesis and compare them to controls. STUDY DESIGN/SETTING Prospective cohort study. PATIENT SAMPLE Forty-two DLS patients. OUTCOME MEASURES The outcome measures included range of sway (RoS) and total sway for the center of mass (CoM) and head in the sagittal, coronal and axial planes, along with leg and back visual analog scale (VAS), Oswestry Disability Index (ODI), Fear/Avoidance Behavior Questionnaire (FABQ), Tampa Scale of Kinesophobia (TSK), and demoralization scale. METHODS Forty-two DLS patients performed a series of functional balance tests a week before and 3 months after surgery and were compared to twenty-six controls. RESULTS RoS for the CoM (p CONCLUSIONS This study confirms that surgical intervention for degenerative spondylolisthesis is effective at reducing disability, back and leg pain, demoralization, kinesiophobia, and fear-avoidance beliefs related to physical activity in patients with DLS. Furthermore, such patients exhibit a significantly more stable stance after surgery. However, balance parameters did not completely normalize by three months post-operatively. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Complications rate of and risk factors for the unplanned reoperation of degenerative lumbar spondylolisthesis in elderly patients: a retrospective single-Centre cohort study of 33 patients

BackgroundThe study was to investigate the complications rate of and risk factors for unplanned reoperation among elderly patients who underwent posterior lumbar fusion (PLF) for degenerative lumbar spondylolisthesis (DLS).MethodsA total of 1100 DLS patients who were older than 60 years were reviewed from January 2006 to December 2016. 33 patients underwent unplanned reoperations and were analysed and divided into two groups (group A: posterolateral fusion, 650 patients; group B: intervertebral fusion, 450 patients). Sex, body mass index (BMI), radiographic data and clinical outcome data were analysed to evaluate the complications rate of and the risk factors for unplanned reoperations.ResultsA total of 33 patients underwent unplanned reoperations (3%). The patients were followed up for an average of 4.20 ± 2.25 years (group A) and 4.32 ± 2.54 years (group B) without a significant difference. Significant differences were found in mean age, levels of involvement, hospital stay, surgery time, and blood loss between the groups. The causes of unplanned operation were wound infection, screw misplacement, neurological deficit, nonunion, and screw fracture, which were significant except for wound infection between the groups. Higher BMI (obesity), diabetes mellitus (DM), more bleeding and sex (female) were risk factors for complications. Cases of screw misplacement, neurological deficit, nonunion and screw fracture in group A were more significant than those in group B.ConclusionPatients with higher BMI, DM, older age, posterolateral fusion, and female sex predicted a higher incidence of unplanned reoperations. Spine surgeons may need to pay more attention to their preoperative training and to improving surgical techniques that could reduce the reoperation rate.

Back pain in surgically treated degenerative lumbar spondylolisthesis: what can we tell our patients?

Summary of background dataSurgery for degenerative lumbar spondylolisthesis (DLS) has traditionally been indicated for patients with neurogenic claudication. Surgery improves patients’ disability and lower extremity symptoms, but less is known about the impact on back pain. ObjectiveTo evaluate changes in back pain after surgery and identify factors associated with these changes in surgically-treated DLS. Study designRetrospective review of prospectively collected data. MethodsThere were 486 consecutive patients with surgically-treated DLS who were enrolled in the Canadian Spine Outcomes Research Network prospective registry and identified for this study. Patients had demographic data, clinical information, disability (Oswestry Disability Index), and back pain rating scores collected prospectively at baseline, and 12 months follow-up ResultsOf the 486 DLS patients, 376 (77.3%) were successfully followed at 12 months. Mean age at baseline was 66.7 (standard deviation [SD] 9.2) years old, and 63% were female. Back pain improved significantly at 12 months, compared with baseline (p<.001). Improvement in Numeric Rating Scale (NRS)-back pain ratings was on average 2.97 (SD 2.5) points at one year and clinically significant improvement in back pain was observed in 75% of patients (minimal clinically important difference (MCID) NRS-Pain 1.2 points). Multivariable logistic regression revealed five factors associated with meeting MCID NRS-back pain at 12 month follow up: higher baseline back pain, better baseline physical function (higher SF-12 Physical Component Score), symptoms duration less than 1 to 2 years, and having no intraoperative adverse events. ConclusionsBack pain improved significantly for patients treated surgically for DLS at 1-year follow-up.

Lumbar Decompression and Interbody Fusion Improves Gait Performance, Pain, and Psychosocial Factors of Patients With Degenerative Lumbar Spondylolisthesis.

Study Design:Prospective cohort study.Objective:Evaluate changes in gait, pain, and psychosocial factors among degenerative lumbar spondylolisthesis (DLS) patients before and 3 months after surgical intervention.Methods:Forty-four symptomatic DLS patients performed clinical gait analysis 1 week before surgery and 3 months after surgery. Patients performed a series of over-ground gait trials at a self-selected speed. Twenty-two matched asymptomatic controls underwent the same battery of tests. Three-dimensional motion tracking was used to analyze gait kinematics. Patient-reported outcomes, gait range of motion, and spatiotemporal parameters compared before and after lumbar decompression with fusion.Results:Surgical intervention resulted in significant improvements in walking speed (P = .021), stride time (P = .020), step time (P = .014), and single-support time (P = .038). Significant improvements in joint range-of-motion were found for knee (P = .002) and hip flexion (P = .006). Degenerative lumbar spondylolisthesis patients reported significant reductions in pain, disability, and improved psychological perceptions for fear-avoidance of pain and motion (all P < .001).Conclusions:Surgical treatment of DLS resulted in a faster, more efficient gait in addition to significant reductions in pain, disability, and psychological fear associated with pain and motion. These beneficial changes that we identified early in the postoperative period indicate that patients return to the quality of life they seek early on. Clinical gait analysis provides objective, quantifiable measures of gait parameters that provide new insight into both the preoperative disability associated with DLS and into the early postoperative function of patients during their rehabilitation.

The Effect of Surgical Decompression and Fusion on Functional Balance in Patients With Degenerative Lumbar Spondylolisthesis.

Prospective cohort study. To quantify the effect of lumbar decompression and fusion surgery on balance and stability in patients with degenerative lumbar spondylolisthesis (DLS) and compare them to controls. DLS is a condition in which one vertebra subluxates relative to an adjacent vertebra in the absence of a disruption in the neural arch. While the existing literature demonstrates that decompression and fusion can successfully alleviate pain and reduce disability in patients with DLS, no studies to date have used quantitative dynamic testing to determine the effect of surgery on cone of economy (CoE) measures in this patient population. Forty-five DLS patients performed a series of functional balance tests a week before and 3 months after surgery and were compared to 28 controls. The outcome measures included range of sway (RoS) and total sway for the center of mass (CoM) and head in the sagittal, coronal, and axial planes, along with leg and back Visual Analog Scale (VAS), Oswestry Disability Index (ODI), Fear/Avoidance Behavior Questionnaire (FABQ), Tampa Scale of Kinesophobia (TSK), and Demoralization scale. RoS for the CoM (P < 0.005) and head (P < 0.017) decreased in all planes postoperatively. Reductions in CoM (P = 0.001) and head total sway (P = 0.001) were also observed after surgery. Furthermore, patients with DLS reported strong improvements in VAS low back (P = 0.001), VAS leg (P = 0.001), ODI (P = 0.001), FABQ Physical (P = 0.003), TSK (P = 0.001), and demoralization (P = 0.044) with surgical intervention. Although total sway was reduced after surgery, it did not return to the level of normal controls as demonstrated with more total sway of their CoM (P = 0.002) and head (P = 0.001) as well as more sagittal head RoS (P = 0.048). This study confirms that surgical intervention for degenerative spondylolisthesis is effective at reducing disability, back and leg pain, demoralization, kinesiophobia, and fear-avoidance beliefs related to physical activity in patients with DLS. Furthermore, such patients exhibit a significantly more stable stance after surgery. However, balance parameters did not completely normalize by 3 months postoperatively. 3.

Efficacy and radiographic analysis of oblique lumbar interbody fusion for degenerative lumbar spondylolisthesis

BackgroundTo compare the clinical efficacy and radiographic analysis of oblique lumbar interbody fusion (OLIF) and traditional posterior lumbar interbody fusion (PLIF) in treating degenerative lumbar spondylolisthesis (DLS).MethodsGrade I DLS patients admitted to the Third Hospital of Hebei Medical University were retrospectively reviewed. In sum, 78 patients that underwent OLIF (n = 31) and PLIF (n = 47) treatment of DLS were recruited. Clinical data including clinical and radiological evaluations were collected pre-operatively and at each follow-up. Japanese Orthopaedic Association (JOA) scores, Oswestry Disability Index (ODI), lumbar lordosis (LL), disc height (DH), and fusion rates were compared between the OLIF and PLIF groups.ResultsThe operation time for both groups was 131.3 ± 14.6 min in the OLIF group and 156.9 ± 37.4 min in the PLIF group (P < 0.001). The intraoperative blood loss was 163.6 ± 63.9 ml in the OLIF group and 496.8 ± 122.6 ml in the PLIF group (P < 0.001). The length of the surgical incision was 4.63 ± 0.57 cm in the OLIF group and 11.83 ± 1.37 cm in the PLIF group (P < 0.001). The number of intraoperative and post-operative complications for both groups was 10 in the OLIF group and 20 in the PLIF group. Significant clinical improvement (P < 0.05) was observed in JOA scores and ODI when comparing pre-operative evaluation and final follow-up. After statistical analysis, there was no significant difference in the preoperative JOA scores between the two groups. There was no significant difference when comparing pre-operative LL and DH for either group. Post-operative reexamination was improved as compared to pre-operative exams. And the improvement of DH was better in the OLIF group as compared to the PLIF group.ConclusionsFor DLS patients, both OLIF and PLIF can achieve good results. Furthermore, OLIF displays marked advantages including smaller surgical incisions, shorter anesthesia times, decreased intraoperative blood loss, and post-operative pain better relieved.

Wednesday, September 26, 2018 10:35 AM – 12:00 PM Understanding Lumbar Stenosis/Spondylolisthesis: 8. Patient-reported outcomes using ODI, VAS back and leg pain, and PROMIS in low-grade degenerative lumbar spondylolisthesis patients with high versus low pelvic incidence

BACKGROUND CONTEXT When evaluating and treating degenerative lumbar spondylolisthesis (DLS) patients, surgeons often do not think about and measure spino-pelvic parameters (SPPs) like they do for spinal deformity and isthmic spondylolisthesis patients. Few studies have looked at the association between patient-reported outcomes (PROs) such as those from Patient-Reported Outcomes Measurement Information System (PROMIS) and SPPs in the low-grade DLS population. A recent study showed an association between global sagittal imbalance and poor PROs in these patients. PURPOSE We aimed to determine if there is an association between PROs and pelvic incidence (PI) in low-grade DLS patients undergoing 1-2 level decompression and fusion. STUDY DESIGN/SETTING Retrospective cohort study, single institution. OUTCOME MEASURES Oswestry Disability Index (ODI), Visual Analog Scale (VAS) Back and Leg Pain. Patient-Reported Outcomes Measurement Information System (PROMIS) Computer Adaptive Tests (CAT) for physical function (PF), pain, depression and anxiety. All measured at baseline, initial, 6-month and 1-year follow-up. METHODS All Myerding grade 1 or 2 DLS patients who underwent 1-2 level decompression and fusion with at least 1-year of follow-up at our institution from August 2015 to October 2017 were retrospectively identified. Patients with high PI (>55°) and low PI ( RESULTS Fifty-nine patients were included with 44 (74.6%) high PI and 15 (25.4%) low PI. Demographics, comorbidities, surgical factors, postoperative complications, fusion status, PI-LL mismatch, and PRO measures were not significantly different (p>0.05) between the groups. In high PI patients, all PRO measures significantly improved (p≤0.05) after surgery compared to baseline at each follow-up. In low PI patients, VAS Back and Leg Pain and PROMIS PF and Pain significantly improved at initial follow-up, PROMIS Pain significantly improved at 6-month follow-up, and ODI, VAS Leg Pain and PROMIS PF and Pain significantly improved at 1-year follow-up. CONCLUSIONS PI does not make a significant difference in PROs in low-grade DLS patients undergoing 1-2 level decompression and fusion. High PI patients significantly improved in all PRO measures after surgery. Low PI patients either significantly improved or trended toward improvement in all PRO measures after surgery. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Does kyphotic configuration on upright lateral radiograph correlate with instability in patients with degenerative lumbar spondylolisthesis?

ObjectiveTo investigate the segmental instability of degenerative lumbar spondylolisthesis (DLS) with a kyphotic configuration at the involved segment, and to determine the most useful diagnostic modalities in the evaluation of instability. Patients and methodsThis study reviewed a consecutive series of patients with L4/5 DLS between July 2010 and May 2016. The enrolled patients were divided into two groups based on preoperative neutral radiographs: the kyphotic group (Group K) and non-kyphotic group (Group NK). Translational and angular motion was determined by comparing upright lateral radiograph (U) with a supine sagittal MR image(S) (Combined, US) or flexion/extension radiographs (FE). ResultsThere were 26 and 201 patients in Groups K and NK, respectively. In comparison to Group NK, Group K demonstrated significantly higher translational motion (12.4% vs. 7.0%, P < 0.001) on US analysis, but significantly lower translational motion (4.2% vs. 6.4%, P < 0.001) on FE analysis. Angular motion was detected to be significantly lower in US versus FE in Group NK (1.2° vs. 7.8°, P < 0.001), while of no difference in Group K (P > 0.05). In Group K, “instability” was recognized in 84.6% of patients using US versus 11.5% patients using FE (P < 0.001); While in Group NK, no significant difference was observed in the incidence of “instability” between FE and US (31.3% vs. 27.8%, P = 0.444). Overall, Group K had a significantly higher incidence of instability than Group NK (84.6% vs. 31.3%, P < 0.001). ConclusionDLS with a kyphotic configuration is a distinct subgroup associated with segmental instability. The modality of US is shown to be superior to traditional FE in measuring translational motion and identifying instability for DLS patients with a kyphotic configuration.

Evaluation of foraminal cross-sectional area in lumbar spondylolisthesis using kinematic MRI.

To evaluate the kinematic change of cross-sectional area of lumbar intervertebral foramen in degenerative lumbar spondylolisthesis patients using multi-positional MRI. Multi-positional MRI was performed on 31 patients diagnosed with single or multilevel degenerative lumbar spondylolisthesis and 31 control patients without degenerative lumbar spondylolisthesis. Foraminal area (FA) was measured at the lumbar spondylolisthesis level in degenerative lumbar spondylolisthesis group and at L3-4, L4-5, and L5-S1 level in the control group. FA was measured bilaterally in neutral, flexion, and extension positions. The difference in FA between the groups was analyzed using Mann-Whitney U test, and the difference between positions within groups was analyzed using Wilcoxon signed-rank test. Degenerative lumbar spondylolisthesis group showed significantly smaller FA on both sides and on average in all three positions compared to the control group (p < 0.05 all). From neutral to flexion position, the change in FA was significantly smaller in the degenerative lumbar spondylolisthesis group than in the control group on both sides and on average (p < 0.005 all). In degenerative lumbar spondylolisthesis group, the FA showed no significant change from neutral to flexion, but showed significant change from neutral to extension (p < 0.005 all). FA in the degenerative lumbar spondylolisthesis group was smaller than in the control group. There was no difference in FA in degenerative lumbar spondylolisthesis group from neutral to flexion, only from neutral to extension. Patients with degenerative lumbar spondylolisthesis have a higher chance of developing foraminal stenosis.

Treatment of degenerative lumbar spondylolisthesis by using minimally invasive transforaminal lumbar interbody fusion and percutaneous pedicle screw fixation

Objective To discuss clinical therapeutic effects of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) combined with percutaneous pedicle screw fixation for degenerative lumbar spondylolisthesis (DLS). Methods A total of 32 DLS patients treated by MIS-TLIF and percutaneous pedicle screw fixation from January 2013 to September 2015 in Xuanwu Hospital, Capital Medical University were retrospectively reviewed. Visual Analogue Scale (VAS), Oswestry Disability Index (ODI) and Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) scores were assessed and compared between preoperation and one week, 3 months after operation and in the last follow-up. Lumbar lordosis angle, coronal Cobb angle, coronal and sagittal body shifting, complication, the degree of spondylolisthesis (Meyerding classification) and the rate of spondylolisthesis were measured according to preoperative and postoperative spinal X-ray examination. Fusion rate was evaluated according to X-rays or CT in the last follow-up, and MRI was used to assess the degree of decompression. Results Thirty-two patients were under test with mean operation time 160 min, intraoperative blood loss 120 ml, postoperative hospital stay 7.22 d and follow-up 10.83 months. Decompression and fusion levels ranged from L2-S1 and interbody fusion was performed in 32 patients and 41 levels were fused. Compared with preoperation, the VAS and ODI scores were significantly increased at one week, 3 months after operation and in the last follow-up ( P = 0.000, for all), while SF-36 score ( P = 0.002, 0.000, 0.000), lumbar lordotic angle ( P = 0.000, for all), coronal Cobb angle ( P = 0.000, for all) and slippage rate ( P = 0.000, for all) were significantly decreased. The fusion rate was 92.22%, and the improvement rate of ODI was (80.51 ± 6.02)% in the last follow-up. There were 3 cases appeared complications, including one case of infection and 2 cases of cerebrospinal fluid (CSF) fistula, and were cured after treatment. Neurological defects, internal fixation failure, breakage of pedicle screw or titanium rod, or Cage displacement were not found in 32 cases. There was no death. Conclusions MIS-TLIF combined with percutaneous pedicle screw fixation is an effective technique for treatment of DLS patients, with less injury, less intraoperative blood loss, low complication incidence rate, good scoliosis correction and definite therapeutic effects, even this method needs more operation time, longer learning curve and more radiation. DOI: 10.3969/j.issn.1672-6731.2016.03.003

Outcomes of Fluoroscopically Guided Lumbar Transforaminal Epidural Steroid Injections in Degenerative Lumbar Spondylolisthesis Patients

Study DesignA prospective cohort.PurposeTo report the short and long term outcomes of fluoroscopically guided lumbar transforaminal epidural steroid injection (TFESI) in degenerative lumbar spondylolisthesis (DLS) patients.Overview of LiteratureTFESI has been widely used for the treatment of lumbosacral radicular pains. However, to our knowledge, there has been no study which has evaluated the outcomes of TFESI in patients with DLS.MethodsThe DLS patients received fluoroscopically guided lumbar TFESI with 80 mg of methylprednisolone and 2 mL of 1% lidocaine hydrochloride. Patients were evaluated by an independent observer before the initial injection, at 2 weeks, at 6 weeks, at 3 months, and at 12 months after the injections. Visual analog scale (VAS), Roland 5-point pain scale, standing tolerance, walking tolerance, and patient satisfaction scale were evaluated for outcomes.ResultsThirty three DLS patients treated with TFESI, who were completely followed up, were included in this study. The average number of injections per patient was 1.9 (range from 1 to 3 injections per patient). Significant improvements in VAS and Roland 5-point pain scale were observed over the follow up period from 2 weeks to 12 months. However, the standing and walking tolerance were not significantly improved after 2 weeks. At 2 weeks, the patient satisfaction scale was highest, although, these outcomes declined with time. The DLS patients with one level of spinal stenosis showed significantly better outcome than the DLS patients with two levels of spinal stenosis. Five patients (13%) underwent surgical treatment during the 3 to 12 months follow up.ConclusionsTFESI provides short term improvements in VAS and Roland 5-point pain scale, standing tolerance, walking tolerance and patient satisfaction scale in DLS patients. In the long term, it improves VAS but limits the improvements in Roland 5-point pain scale, standing tolerance, walking tolerance and patient satisfaction scale.

Lumbar Facet Joint Motion in Patients With Degenerative Spondylolisthesis

Controlled laboratory study. To investigate the in vivo biomechanical effect of degenerative lumbar spondylolisthesis (DLS) on the motion of the facet joint during various functional weight-bearing activities. Although the morphologic changes of the facet joints in patients with DLS have been reported in a few studies, no data have been reported on the kinematics of these facet joints. Ten patients with DLS at L4-L5 were studied. Each patient underwent a magnetic resonance imaging scan to obtain 3-dimensional models of the lumbar vertebrae from L2-L5 and a dual fluoroscopic imaging scan in different postures: flexion-extension, left-right bending, and left-right torsion. The positions of the vertebrae were reproduced by matching the magnetic resonance imaging-based vertebral models to the fluoroscopic images. The kinematics of the facet joint and the ranges of motion were compared with those of healthy subjects and those of patients with degenerative disk diseases (DDD) previously published. In DLS patients, the range of rotation of the facet joints was significantly less at the DLS level (L4-L5) than that at the adjacent levels (L2-L3 and L3-L4), whereas the range of translation was similar at all levels. The range of rotation at the facet joints of the DLS level decreased compared with those of both the DDD patients and healthy subjects at the corresponding vertebral level (L4-L5), whereas no significant difference was found in the range of translation. The range of motion of facet joints in DLS and in DDD patients was similar at the adjacent levels (L2-L3 and L3-L4). The range of rotation decreased at the facet joints at the DLS level (L4-L5) in patients compared with those in healthy subjects and DDD patients. This decrease in range of rotation implies that the DLS disease may cause restabilization of the joint. The data may help the selection of conservative treatment or different surgical techniques for the DLS patients.

腰椎変性すべり症に対する低侵襲除圧術の手術成績 —棘突起正中縦割進入 vs. 片側進入—

腰椎変性すべり症に対する低侵襲除圧術の手術成績 —棘突起正中縦割進入 vs. 片側進入—