More than 5 year-Follow-Up After Pedicle Screw Fixation and Fusion for Isthmic Spondylolisthesis

Jae Chul Lee; Seok-Ha Hwang; Jae-Wan Soh; Yon-Il Kim; Byung-Joon Shin

doi:10.4184/jkss.2007.14.3.178

Journal List > J Korean Soc Spine Surg > v.14(3) > 1035770

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Lee, Hwang, Soh, Kim, and Shin: More than 5 year-Follow-Up After Pedicle Screw Fixation and Fusion for Isthmic Spondylolisthesis

Original Article

Journal of Korean Spine Surg 2007;14(3):178-186.

Published online: 21 February 2007

DOI: https://doi.org/10.4184/jkss.2007.14.3.178

More than 5 year-Follow-Up After Pedicle Screw Fixation and Fusion for Isthmic Spondylolisthesis

Jae Chul Lee, M.D., Seok-Ha Hwang, M.D., Jae-Wan Soh, M.D., Yon-Il Kim, M.D., Byung-Joon Shin, M.D.

Department of Orthopaedic Surgery, Spine Center, Soonchunhyang University College of Medicine, Seoul, Korea

Address reprint requests to Byung-Joon Shin, M.D. Department of Orthopaedic Surgery Soonchunhyang University College of Medicine 657 Hannam-dong, Yongsan-gu, Seoul, Korea Tel: 82-2-709-9250, Fax: 82-2-794-9414, E-mail: schsbj@hosp,sch.ac.kr

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study Design

A retrospective study.

Objectives

The aim of this study was to analyze the long term followup results of the isthmic spondylolisthesis patients who had been treated with pedicle screw fixation and fusion, and were followed up for more than 5 years. An attempt was made to determine the differences between posterior lumbar interbod fusion(PLIF) and posterolateral fusion (PLF).

Summary of Literature Review

The surgical treatment of isthmic spondylolisthesis has developed markedly after the introduction of spine fusion and pedicle screw fixation. However, the longterm prognosis after such treatments has not been investi-gated sufficiently.

Materials and Methods

Among 53 patients, 38(72%) patients were examined more than 5 years after surgery. The clinical results were evaluated according to Kim's criteria. Radiologically, the degree of slippage and disc height was measured. The changes in the adjacent segments were also observed.

Results

PLIF was performed in 26 patients and PLF was performed in 12 patients. In the PLIF group, the clinical results were ‘excellent’ in 15 patients, ‘good’ in 8, ‘fair’ in 2, and ‘poor’ in 1. In the PLF group, the results were ‘excellent’ in 8 patients, ‘good’ in 2, ‘fair’ in 1, and ‘poor’ in 1. According to the fusion method, a satisfactory outcome was obtained in 89% of patients in the PLIF group, and 83% in the PLF group, without any statistically significant differences. Radiological analysis was available in 28(52.8%) patients. There were no statistically significant differences between the PLIF and PLF groups in terms of the reduction and maintenance of slippage and the disc height.

Conclusions

The clinical result of isthmic spondylolisthesis patients who were treated with pedicle screws and fusion were satisfactory in 87% of patients. The clinical and radiological comparison of the fusion methods showed no significant differences between the PLIF and PLF groups.

Keywords: Isthmic spondylolisthesis, Pedicle screw fixation, Posterior lumbar interbody fusion, Posterolateral fusion

REFERENCES

1). Jacobs WC, Vreeling A, De Kleuver M. Fusion for low-grade adult isthmic spondylolisthesis: a systematic review of the literature. Eur Spine J. 2006; 15:391–402.

2). Carragee EJ. Single-level posterolateral arthrodesis, with or without posterior decompression, for the treatment of isthmic spondylolisthesis in adults. A prospective, randomized study. J Bone Joint Surg Am. 1997; 79:1175–1180.

3). Deguchi M, Rapoff AJ, Zdeblick TA. Posterolateral fusion for isthmic spondylolisthesis in adult: analysis of fusion rate and clinical result. J Spinal Disord. 1998; 11:459–464.

4). De Loubresse CG, Bon T, Deburge A, Lassale B, Benoit M. Posterolateral fusion for radicular pain in isthmic spondylolisthesis. Clin Orthop Relat Res. 1996; 323:194–201.

5). Kim NH, Kim DJ. Anterior interbody fusion for spondylolisthesis. Orthopedics. 1991; 14:1069–1076.

6). Taillard W. Spondylolisthesis in children and adolescents. Acta Orthop Scand. 1954; 24:115–144.

7). Lenke LG, Bridwell KH, Bullis D, Betz RR, Baldus C, Schoenecker PL. Results of in situ fusion for isthmic spondylolisthesis. J Spinal Disorder. 1992; 5:433–442.

8). Hashimoto T, Shigenobu K, Kanayama M, Harada M, Oha F, Ohkoshi Y, Tada H, Yamamoto K, Yamane S. Clinical Results of single-level posterior lumbar interbody fusion using the Brantigan I/F carbon cage filled with a mixture of local morselized bone and bioactive ceramic granules. Spine. 2002; 27:258–262.

9). Esses SI, Natout N, Kip P. Posterior interbody arthrodesis with a fibular strut graft in spondylolisthesis. J Bone Joint Surg Am. 1995; 77:172–176.

10). Ray CD. Threaded Titanium Cages for lumbar Interbody Fusions. Spine. 1997; 22:667–679.

11). Suk SI, Lee CK, Kim WJ, Lee JH, Cho KJ, Kim HG. Adding posterior lumbar interbody fusion to pedicle screw fixation and posterolateral fusion after decompression in spondylolytic spondylolisthesis. Spine. 1997; 22:210–220.

12). Stauffer RN, Coventry MB. Posterolateral lumbar spine fusion. J Bone Joint Surg Am. 1972; 54:1195–1204.

13). Herkowitz HN, Kurz LT. Degenerative lumbar spondylolisthesis with spinal stenosis. A prospective study com-paring decompression with decompression and intertransverse process arthrodesis. J Bone Joint Surg Am. 1991; 73:802–808.

14). Rothman RH, Simeone FA. The surgical treatment of spondylolisthesis in adult in the spine. 3rd ed.Philadelphia: WB Saunders Co:;1992. p. 913–969.

15). Fraser RD. Interbody, posterior and combined lumbar fusions. Spine. 1995; 15:167S–177S.

16). Kuslich SD. Lumbar interbody cage fusion for back pain. Spine. 1999; 13:295–311.

17). Madan S, Boeree NR. Outcome of posterior lumbar interbody fusion versus posterolateral fusion for spondylolytic spondylolisthesis. Spine. 2002; 27:1536–1542.

18). Inamdar DN, Alagappan M, Shyam L, Devadoss S, Devadoss A. Posterior lumbar interbody fusion versus intertransverse fusion in the treatment of lumbar spondylolisthesis. J Orthop Surg (Hong Kong). 2006; 14:21–26.

19). La Rosa G, Conti A, Cacciola F, et al. .:. Pedicle screw fixation for isthmic spondylolisthesis: does posterior lumbar interbody fusion improve outcome over posterolateral fusion? J Neurosurg. 2003; 99:143–150.

20). Kumar MN, Jacquot F, Hall H. Longterm followup of functional outcomes and radiographic changes at adjacent levels following lumbar spine fusion for degenerative disc disease. Eur spine J. 2001; 10:309–313.

21). Rahm MD, Hall BB. Adjacent-segment degeneration after lumbar fusion with instrumentation; a retrospective study. J Spinal Disord. 1996; 9:392–400.

Figures and Tables%

Fig. 1.

Preoperative and final followup anteroposterior and lateral radiograph in a 47-year-old woman. (A) Isthmic spondylolisthesis was found at L4. (B) Nine year after surgery, plain radiographs shows maintenance of correction and solid posterolateral fusion mass.

Fig. 2.

(A) Initial myelogram of a 57-year-old woman with spondylolytic spondylolisthesis L5 on S1. (B) Lateral radiograph at 12 year followup shows maintenance of correction. (C) Anteroposterior and lateral myelogram at 14 year followup shows stenosis of L3-4, L4-5. (D) At the revision surgery, decompression and interbody fusion was extended to the L3-4 and L4-5 level without removing S1 and sacral alar screws.

Table 1.

Criteria for clinical result (by Kim's)

Excellent	Complete relief of pain in back and lower limbs
	No limitation of physical activity
	Analgesics not used at all
Good	Relief of most of pain in back and lower limbs
	Able to return to accustomed employment
	Physical activities slightly limited
	Analgesics used only infrequently
Fair	Partial relief of pain in back and lower limbs
	Able to return to accustomed employment with
	limitation or return to higher work
	Physical activities definitely limited
	Mild analgesic medication frequently
Poor	Little or no relief of pain in back and lower limbs
	Physical activities greatly limited
	Unable to return to accustomed employment
	Analgesic medication used regularly

Table 2.

Data of 28 patients who were followed more than 5 years by radiographs

No.	Age (year)	Sex	Follow up period (month)	Involved levels	Fusion method	Clinical outcome	Slip percentage			Disc heights			Complications
No.	Age (year)	Sex	Follow up period (month)	Involved levels	Fusion method	Clinical outcome	Preop.	Imm. PO.	Final	Preop.	Imm. PO.	Final	Complications
11	58	F	172	L5-S1	PLIF	excellent	22.0	11.6	13.6	26.5	34.3	23.7	donor site pain
12	59	F	184	L4-5	PLIF	excellnet	34.1	18.6	25.0	26.7	33.3	30.3	donor site pain
13	41	F	187	L4-5	PLIF	excellent	16.3	15.0	15.0	43.3	36.4	27.3
14	61	F	172	L5-S1	PLIF	fair	35.0	10.0	15.0	31.3	25.0	26.7
15	34	F	198	L4-5	PLIF	good	27.3	14.5	14.8	24.1	41.4	39.3
16	42	F	181	L3-4	PLIF	excellent	14.3	11.9	15.0	30.0	40.0	33.3	L4-5 junctional problem
17	46	F	169	L5-S1	PLIF	excellent	20.0	10.0	19.3	23.3	25.8	25.8	dural tear, foot drop
18	37	F	160	L5-S1	PLIF	good	26.3	15.0	17.1	30.3	30.3	25.7
19	47	F	105	L4-5	PLIF	good	33.3	14.7	15.6	15.6	23.3	20.0
10	59	F	120	L4-5	PLIF	poor	16.7	14.9	13.2	16.7	25.0	22.2	donor site pain
													L2 compression fracture
													L5-S1 listhesis
11	49	F	108	L5-S1	PLIF	excellent	31.0	19.8	14.0	21.9	31.3	30.0	donor site pain
12	53	M	167	L4-5	PLIF	good	17.4	16.7	19.8	19.4	35.7	25.0
13	61	F	120	L4-5	PLIF	excellent	29.3	25.0	25.0	25.8	40.6	26.7	donor site pain
14	38	M	197	L5-S1	PLIF	excellent	14.6	12.2	12.2	34.4	39.4	27.3	dural tear
15	44	M	179	L4-5	PLIF	good	16.3	14.0	14.0	31.3	37.5	30.0
16	47	F	185	L4-5	PLIF	good	20.5	12.5	12.2	32.1	30.0	28.6
17	52	F	152	L5-S1	PLIF	excellent	25.6	16.8	17.0	16.1	45.2	28.1	retrolisthesis
18	41	M	196	L5-S1	PLIF	excellent	20.6	11.1	19.1	51.9	46.7	36.7
19	56	F	172	L4-5	PLIF	excellent	26.8	14.0	12.2	17.9	30.0	20.7	L3 compression fracture
20	46	M	120	L4-5	PLIF	fair	15.0	15.0	15.0	35.3	38.2	25.0
21	42	M	120	L3-4-5	PLF	excellent	29.2	12.8	10.9	33.3	41.2	19.4	dural tear
													stitch abscess
													donor site pain
													retrolisthesis
22	42	F	143	L4-5	PLF	excellent	19.3	12.3	4.5	28.1	46.7	32.3
23	53	M	176	L3-4-5	PLF	excellent	18.4	11.1	12.8	32.0	41.7	21.9	retrolisthesis
24	58	F	197	L5-S1	PLF	poor	39.0	15.0	9.1	7.1	26.7	16.7	L3-4-5 junctional problem
25	50	F	80	L4-5	PLF	fair	22.2	18.9	21.7	25.7	28.6	17.1
26	57	F	105	L4-5-S1	PLF	excellent	21.4	12.5	19.0	32.1	34.5	32.0
27	55	F	60	L3-4-5	PLF	good	34.9	19.0	21.4	31.0	35.5	30.0	coronal imbalance
28	39	F	124	L4-5	PLF	excellent	17.3	12.4	2.5	33.3	31.0	24.1

No.: patient number, PLIF: posterior lumbar interbody fusion, PLF: posterolateral fusion, Preop.: preoperative, Imm. PO.: immediate postoperative, Final: final followup

Table 3.

Clinical results

	PLIF (%) (n=26)	PLF (%) (n=12)
Excellent	15(57.7%)	8(66.7%)
Good	18(30.8%)	2(16.7%)
Fair	12(37.7%)	1(38.3%)
Poor	11(33.8%)	1(38.3%)

PLIF: posterior lumbar interbody fusion, PLF: posterolateral fusion

Table 4.

Change of slip percentage

	Preop.	Imm. PO.	Final
PLIF (n=20)	23.1±17.0%	10.2±5.3%	12.2±5.6%
PLF (n=8)	22.7±11.3%	19.3±5.8%	12.7±7.4%
Total (n=28)	23.0±18.1%	19.9±5.3%	12.4±6.0%

p=0.905 PLIF vs PLF (by repeated measures ANOVA) PLIF: posterior lumbar interbody fusion, PLF: posterolateral fusion Preop.: preoperative, Imm. PO.: immediate postoperative

Table 5.

Change of relative disc heights

	Preop.	Imm. PO.	Final
PLIF (n=20)	27.7±9.3%	34.5±6.8%	27.6±4.8%
PLF (n=8)	27.8±8.8%	35.7±7.0%	24.2±6.5%
Total (n=28)	27.7±9.0%	34.8±6.8%	26.6±5.5%

p=0.784 PLIF vs PLF (by repeated measures ANOVA) PLIF: posterior lumbar interbody fusion, PLF: posterior lateral fusion Preop.: preoperative, Imm. PO.: immediate postoperative

TOOLS

Similar articles