Management Of Lumbar Spondylolisthesis Research Articles

Automated X-Ray Image Analysis for Lumbar Spondylolisthesis Detection and Severity Grading

Spondylolisthesis, characterized by the anterior displacement of a vertebra, significantly impacts spinal health diagnosis and treatment. This study introduces a groundbreaking machine learning strategy for automated detection and grading of lumbar spondylolisthesis from X-ray images, utilizing Roboflow for data management and a customized convolutional neural network (CNN). This CNN accurately identifies lumbar vertebral segments and objectively grades vertebral slippage. The evaluations show a mean average precision (mAP) of 98.5%, with precision at 96.8% and recall at 97.2%, underscoring the model's accuracy and reliability. Additionally, we developed a user-friendly interface for healthcare professionals, enhancing the tool's clinical applicability. The method offers a significant improvement over existing diagnostic approaches, providing a reliable, efficient solution for the early detection and management of lumbar spondylolisthesis.

Wearable technology and measurement of outcomes from lumbar spondylolisthesis surgery

Accurate assessment markers are crucial in the management of lumbar spondylolisthesis, particularly after surgical intervention. Traditional methods to track surgical outcomes primarily rely on patient-reported outcome measures (PROMs), which capture patients’ perspectives on their health and recovery. However, PROMs are subjective and susceptible to bias, affecting their reliability. To overcome these limitations, wearable devices have emerged as valuable tools for tracking real-life mobility and objectively assessing surgical outcomes. These devices provide continuous, remote collection of various health metrics and have been shown to have high efficacy and patient compliance. This chapter reviews the current landscape of combining wearable technology data and PROMs in assessing lumbar surgery outcomes, with a focus on spondylolisthesis patients. Both objective physical activity data and subjective clinical scores demonstrate similar trends in postoperative recovery. However, attempts to correlate these metrics have produced mixed results due to the variation in devices and PROMs used. Establishing standardized protocols for wearable usage and data reporting is crucial for maximizing their utility in monitoring spine patients effectively. Overall, integrating wearable technology with PROMs holds significant potential to enhance postoperative monitoring, improve personalized care, and optimize patient recovery. Future applications may involve predicting outcomes and tailoring interventions based on objective activity data in the early postoperative stage, ultimately leading to better patient outcomes and improved healthcare delivery.

Evaluation of Transpedicular Screws Fixation with Posterior Interbody Fusion by Cage in Management of Lumbar Spondylolisthesis

Evaluation of Transpedicular Screws Fixation with Posterior Interbody Fusion by Cage in Management of Lumbar Spondylolisthesis

Functional Outcome of Instrumentation and Interbody Cage Fusion in Cases of Lumbar Spondylolisthesis

Background: Primary lumbar vertebral instability or “spondylolisthesis” is perhaps one of the commonest radiological sign associated with lumbo-sacral pain after the third decade of life. Aims and Objectives: To find out the functional outcome in terms of clinical improvement in cases of single level lumbar spondylolisthesis by bone grafting and interbody cage fusion and pedicle screw fixation after decompression of neural elements. Materials and Methods: All the patients were evaluated by anteroposterior and lateral radiographs of the lumbosacral spine centered at the appropriate level. In all cases flexion and extension views were taken to assess the instability. More than 4 to 5 mm of sagittal translation and 10 degrees of rotation were considered as instability. All cases were evaluated further by MRI to evaluate facet joint pathology, sacralization/lumbarisation and to find the associated disc changes and the nerve root involvement. All patients were treated by decompression and interbody fusion with cage and bone graft by either Transforaminal or Posterior approach and instrumentation done with pedicle screws. Post operatively all patients were assessed for the functional outcome using the Oswestry Disability Index at 1 month, 3 month and 6 months Results: There is statistically significant difference in ODI Scores (Oswestry Disability Index) post operatively at 1 month, 3 month and 6 months. Conclusion: In agreement with good results, found in our study, we strongly believe that this technique of fusion and instrumentation is very useful in management of lumbar spondylolisthesis. However, this study should further be extended to a wider sample of patients with a longer follow-up.

A Prospective Randomized Study of the Safety and Efficacy of Transforaminal Lumbar Interbody Fusion Versus Posterior Lumbar Interbody Fusion in the Treatment of Lumbar Spondylolisthesis: A Cost utility from a Lower-middle-income Country Perspective and Review of Literature

BACKGROUND: The safety and efficacy of transforaminal lumbar interbody fusion (TLIF) and posterior lumbar interbody fusion (PLIF) in lumbar spondylolisthesis have not been validated in many prospective randomized trials. AIM: We aimed to validate the safety and efficacy of TLIF and PLIF surgery in lumbar spondylolisthesis using the clinical, radiographic, and cost-utility outcomes. METHODS: The data of surgically treated single-level spondylolisthesis patients were randomized prospectively into two groups. The groups were compared regarding demographics, perioperative complications, hospital stay, total expenditure, fusion rate, and clinical outcomes (visual analog scale, Oswestry disability index, Zurich claudication scale, and Odom’s criteria). A review of literature was done to compare the outcomes with the ones from higher-income nations. RESULTS: Thirty-three patients underwent prospective randomization. The improvement in the clinical outcomes at 12-month follow-up showed improvement in the TLIF group more than the PLIF group but with no significant difference. The mean operative time was significantly longer in the PLIF (p < 0.05), also, the blood loss was significantly less in the TLIF (p < 0.001). The complications frequency did not show any statistical significance between both groups and no significant difference in the patient’s post-operative patient satisfaction (p = 0.6). The mean hospital stay was non-significantly longer in the PLIF (p = 0.7). At 12-month follow-up, 93.3% of the TLIF patients were fused versus 86.7% of the PLIF (p = 0.5). The total cost of the TLIF was significantly less (p < 0.001). CONCLUSION: Both PLIF and TLIF could achieve similar fusion rates and clinical satisfaction in the management of lumbar spondylolisthesis. The TLIF group was significantly better in terms of financial burden, operative time, and blood loss.

Minimally Invasive Versus Open TLIF in the Management of Lumbar Spondylolisthesis

This study aims to assess the difference between minimal invasive TLIF surgery and conventional TLIF surgery in cases of lytic spondylolisthesis, as regards pain, disability, hospital stay and complications. Lytic Spondylolisthesis patients may require fusion of one or more spinal segments to treat their condition adequately. The chances of achieving a successful lumbar spinal fusion has increased. TLIF technique is gradually being accepted in these cases and widely used by most spine surgeons. Minimal invasive TLIF is a recent trend for spinal fusion. This is a prospective randomized comparative study conducted from March 2016 to December 2018 included forty patients with low grade lytic spondylolisthesis that underwent surgeries. Twenty patients underwent MI-TLIF through percutaneous posterior lumbar pedicular screw fixation, microscopic minimally invasive transformational discectomy and interbody cage fusion (patients group “A”) and another twenty patients underwent traditional open posterior lumbar pedicular screw fixation and TLIF (control group “B”). In our results, both surgical techniques showed improvement in pain and function within 12 months (follow up period), but group A showed statistically significant improvement in pain and function in the 1^st three months. Regarding blood loss, need for transfusion and hospital stay, group A showed statistically significant better results. As a conclusion, minimally invasive TLIF is a better option in surgical management of spondylolisthesis especially in the early postoperative period.

Comparative Utility of Dynamic and Static Imaging in the Management of Lumbar Spondylolisthesis

Segmental instability traditionally is investigated with flexion and extension (F/E) radiographs. We sought to determine whether motion between upright and supine (U/S) views can serve as an alternative sensitive diagnostic tool that predicts similar outcomes. Ambispective collection of data was performed for 222 consecutive patients who underwent transforaminal lumbar interbody fusion. Patients were divided into either group 1 (≥3 mm spondylolisthesis difference between F/E radiographs) or group 2 (≥3 mm spondylolisthesis difference between U/S imaging and otherwise not meeting group 1 criteria). In total, 77 patients metall inclusion/exclusion criteria. Patients in group 1 (n= 26) and group 2 (n= 51) did not differ with respect to key demographic criteria. Average clinical follow-up for groups 1 and 2 were 31.8 and 35.6 months (P= 0.43). Average spondylolisthesis was 8.1 mm and 8.0 mm for groups 1 and 2 (P= 0.93). The incidence of facet joint hyperintensity on T2-weighted magnetic resonance imaging and average maximal facet joint widening (P > 0.2) did not differ between groups. Average F/E slip change was 5.0 mm for group 1 and average U/S slip change was 5.2 mm for group 2. For both groups, Numeric Rating Scale Back Pain and Numeric Rating Scale Leg Pain, Oswestry Disability Index v2.1a, and Short-Form 36 RAND (P < 0.02) improved significantly after surgery. Furthermore, ΔNumeric Rating Scale Back Pain, ΔNumeric Rating Scale Leg Pain, ΔOswestry Disability Index v2.1a, and ΔShort-Form 36 RAND (P > 0.2) were not significantly different between groups. No differences in outcomes were noted between patients based on either imaging criteria. These data suggest that static U/S imaging may identify a distinct group of patients who may benefit from transforaminal lumbar interbody fusion surgery.

358 Lumbar Spondylolisthesis Geographic Variation in Arthrodesis Rates, Costs, and Narcotic Outcomes

Abstract INTRODUCTION The role of arthrodesis in the management of lumbar spondylolisthesis remains controversial. Practice patterns, quality indicators, and narcotic outcomes for this population vary widely. METHODS We identified 67,077 patients (60.7% female, mean age of 59.8 years (SD, 12.0) with lumbar spondylolisthesis who received either laminectomy or laminectomy with arthrodesis in the MarketScan database from 2007 through 2014. We calculated arthrodesis rates, inpatient costs, and narcotic utilization outcomes, adjusted for patient-level demographic factors, and used these results to assess variation beyond differences in patient populations. RESULTS &gt;The majority (91.8%) of patients received arthrodesis; state-level rates varied from 97.5% in South Dakota to 81.5% in Oregon. Adjusting for patient-level characteristics, 15 states had higher than expected arthrodesis rates, such as South Dakota (5.5% greater than expected; P &lt; 0.001), and 10 states had lower than expected arthrodesis rates, such as Oregon (10.0% lower than expected; P &lt; 0.001). Costs of surgery varied from $32,889 in Michigan to $78,096 in New Jersey. Eleven states had costs significantly higher and 20 states with costs significantly lower than expected (each P &lt; 0.05). Patients who had received arthrodesis were significantly less likely to have stopped using narcotics by 6 months after their procedure (OR = 0.89, P &lt; 0.05). Patients undergoing arthrodesis were not significantly more likely to meet the criteria for chronic narcotic use (OR = 1.02). Chronic narcotic use was most strongly associated with pre-operative narcotic use, which ranged from 24.0% in New Mexico to 72.9% in Mississippi. Post-operative narcotic use in the 2 years following surgery varied markedly, from 3753 cumulative morphine milligram equivalents (MMEs) in New Mexico to 30,749 MMEs in Idaho. CONCLUSION There is marked geographic variation in the rates of arthrodesis in treatment of spondylolisthesis within the United States. This variation remains pronounced after accounting for patient-level demographic differences. Costs of surgery and narcotic utilization also vary widely.

Treatment of Adult Spondylolisthesis: PLIF versus PLF: Comparitive Study of Early Functional Outcome

Objective: Aim of this study is to assess and compare the early functional outcomes and results of posterior lumbar interbody fusion (PLIF), and posterolateral fusion (PLF) in the surgical treatment of adult spondylolisthesis. Background: Posterolateral fusion has been considered the best method for surgical treatment of adult spondylolisthesis. This technique had been widely used. Superior results have subsequently been reported with interbody fusion with cages and posterior instrumentation. In axial loading pull out strength and eccentric loading remains a disadvantage for PLF. The problems such as axial pain, loss of reduction, loosening or failure of fixation materials occurred relatively frequently after posterolateral fusion could be improved by an operation that fused vertebral bodies. Materials and Methods: Fourty two patients with lumbar spondylolisthesis were operated with moderate to severe low back pain and/or sciatica. Patients with neurogenic claudication also were included. Randomisation technique was followed to allot patients into two different groups according to the mode of bony fusion into PLIF and PLF groups. Both groups were statistically identical. Results: PLIF and PLF groups had no major differences in blood loss, short-term postoperative clinical result, or complications. Surgical time was slightly prolonged in PLIF when compared to PLF. Visual analog scale for back pain and leg pain, the Oswestry disability index, and fusion rates were significantly better in PLIF. The lumbar lordosis and the segmental angle revealed greater improvement in the PLIF group. Conclusion: PLIF seems to be a better bone fusion technique than PLF in the management of lumbar spondylolisthesis. The problems encountered in PLF technique have been improved in PLIF.

Wiltse approach and posterior midline approach transforaminal lumbar interbody fusion for degenerative lumbar spondylolisthesis: a comparative study

Objective To compare the clinical outcomes of transforaminal lumbar interbody fu- sion （TLIF） through Wiltse approach and posterior midline approach in the treatment of degenerative lum- bar spondylolisthesis. Methods A total of 37 patients with degenerative lumbar spondylolisthesis were treated between March 2008 and March 2010, including 23 patients managed by TLIF via posterior mid- line approach （posterior midline approach group） and 14 by TLIF via Wiltse approach （Wiltse approach group）. The Japanese Orthopaedic Association （JOA） score and visual analogue scale （VAS） before and after operation, and the interbody fusion condition in both the Wiltse approach group and posterior midline approach group were reviewed and the clinical outcomes of both groups were compared. Results The follow-up lasted for 6-26 months （mean, 15.7 months） , during which both groups had obvious relief in clinical symptoms like pain of waist and legs. X-ray photographs showed good spondylolisthesis reduction and interbody fusion, with no loosening or breakage of the internal fixators. The fusion rate of Wiltse ap- proach group and posterior midline approach group at the last follow-up were 86% and 87% , respectively.The operation time of Wiltse approach group and poslerior midline approach group was （ 117. 8 ± 25.6） minutes and （ 128.5±38.7） minutes respeetively （ P 〉 0.05 ）. The intra-operative blood loss of Willse approach group and poslerior midline approach group was （203.5± 16.4） ml and （284.4 ±27.6） ml respectively （ P 〈 0.05 ）. Both groups presented significant decrease of JOA score post-opera- tively （P 〈0.05）. Also, the two groups showed significant difference concerning the VAS score in low back pain one week post-operatively （P 〈0.05）, but no significant difference in terms of VAS score in leg pain at one week after operation （ P 〈 0. 05） and VAS score in pain of low back and legs at the final tollow-up （ P 〉 0. 05 ）. Conclusions In the management of lumbar spondylolisthesis, TLIF via Wihse approaeb and via posterior midline approach can both achieve satisfactory interbody fusion rate anti elini- eal outcomes, but the Wiltse approach results in relatively less intra-operative blood loss and faster post- operative recovery. Key words: Spondylolisthesis; Internal fixators; Transfiraminal lumbar inlerbody fusion

Minimum 10-Year Follow-up Study of Anterior Lumbar Interbody Fusion for Degenerative Spondylolisthesis: Progressive Pattern of the Adjacent Disc Degeneration

Study DesignRetrospective study.PurposeThe aims of the current study are to evaluate the minimum 10-year follow-up clinical results of anterior lumbar interbody fusion (ALIF) for degenerative spondylolisthesis.Overview of LiteratureALIF has been widely used as a treatment regimen in the management of lumbar spondylolisthesis. Still much controversy exists regarding the factors that affect the postoperative clinical outcomes.MethodsThe author performed a retrospective review of 20 patients with degenerative spondylolisthesis treated with ALIF (follow-up, 16.4 years). The clinical results were assessed by the Japanese Orthopaedic Association (JOA) score for low back pain, vertebral slip and disc height index on the radiographs.ResultsThe mean preoperative JOA score was 7.1 ± 1.8 points (15-point-method). At 1 year, 5 years, and 10 years or more after surgery, the JOA scores were assessed as 12.4 ± 2.2 points, 12.7 ± 2.6 points, 12.0 ± 2.5 points, respectively (excluding the data of reoperated cases). The adjacent disc degeneration developed in all cases during the long-term follow-up. The progressive pattern of disc degeneration was divided into three types. Initially, disc degeneration occurred due to disc space narrowing. After that, the intervertebral discs showed segmental instability with translation at the upper level. But the lower discs showed osteophyte formation, and occasionally lead to the collapse or spontaneous union.ConclusionsThe clinical results of the long-term follow-up data after ALIF became worse due to the adjacent disc degeneration. The progressive pattern of disc degeneration was different according to the adjacent levels.