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Abstract
Study Design
This is a retrospective study on the effect of posterior lumbar interbody fusion for maintaining the reduction in isthmic spondylolisthesis patients.
Objectives
We evaluated the efficacy of performing posterior lumbar interbody fusion for maintaining the reduction in isthmic spondylolisthesis.
Summary of the Literature Review
There have been many reports regarding the surgical treatment of spondylolisthesis. A lthough there are many reports that the clinical results have nothing to do with the reduction, many surgeons have tried to maintain the reduction. However, the question about what kind of fusion modality is the most effective for maintaining the reduction is still controversial.
Material and Method
Between A ugust 2002 and January 2004, 24 patients with isthmic spondylolisthesis were operated on.14 underwent posterolateral fusion alone (group A) and 10 underwent additional posterior interbody fusion (group B). These two groups were compared in terms of the clinical results, the radiological changes and fusion rates. Results: the reduction rate were 11.81% and 7.32% in the PLF and PLF+PLIF groups, respectively (p>0.05). The reduction losses were 0.19% and 0.35% in the PLF and PLF+PLIF groups, respectively (p>0.05). The changes after fusion were 0.11% and 0.10% in the PLF and PLF+PLIF groups, respectively (p>0.05). There was no case of nonunion. The satisfaction rates were 86% and 83% in the PLF and PLF+PLIF groups, respectively (p>0.05).
Conclusions
In our study, the addition of posterior interbody fusion showed no benefit in maintaining correction. If solid fusion can be obtained, then posterolateral fusion seems to be sufficient enough to maintain correction in isthmic spondylolisthesis. The authors think that further studies are mandatory because of the small number subjects in our study.
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Fig. 1.
(A) Preoperative lateral radiograph of 49-year-old female shows grade II isthmic spondylolisthesis at L5-S1 level. (B) Postoperative lateral radiograph shows the reduction of spondylolisthesis (48% → 20%). (C) Radiographs at 24 months follow up examination shows maintenance of reduction with solid bony union.
Fig. 2.
(A) Preoperative lateral radiographs of 46-year-old female shows grade II isthmic spondylolisthesis at L4-5 level. (B) Postoperative lateral radiographs shows the reduction of spondylolisthesis (33% → 13%). (C) Radiograph and CT scan at 26 months follow up examination shows maintanace of reduction with solid bony union.
Table 1.
Lenke's fusion grade
Table 2.
Katz's satisfaction scale How Satisfied Are You With:
Table 3.
Loss of Reduction
| Preop. | Postop. | Fusion | Final F/U | Reduction Rate | Reduction Loss | |
|---|---|---|---|---|---|---|
| A | 22.76% | 10.89% | 10.97% | 11.08% | 11.81% | 0.19% |
| B | 20.28% | 12.96% | 13.21% | 13.31% | 07.32% | 0.35% |
| P-value | 00.241 | 0.2810 |
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