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Abstract
Objectives
To evaluate the clinical and radiological outcomes of posterior interbody fusion using pedicle screw fixation after posterior decompression for high-grade spondylolisthesis.
Summary of Literature Review
The surgical treatment of high-grade spondylolisthesis has been controversial. However, few reports on the results of reduction and posterior interbody fusion after posterior decompression have been published.
Materials and Methods
Thirteen patients with L5-S1 high-grade spondylolisthesis (Meyerding grade III, IV) who underwent reduction and posterior interbody fusion were analyzed with at least 2 years of follow-up. The mean age of the patients (male 2, female 11) was 51 years. Classified by the type of spondylolisthesis, 10 cases were isthmic, 2 cases dysplastic, and 1 case degenerative. A visual analogue scale (VAS), the Oswestry Disability Index (ODI) score, bone union, anterior slippage, and slip angle were used in comparing clinical and radiographic outcomes.
Results
All cases showed improvement of preoperative symptoms. The VAS and ODI score improved from a mean of 8.9 points and 36.2 points preoperatively to 2.1 points and 10.2 points, respectively, at last follow-up. The degree of anterior slippage measured by Taillard's method was improved from a mean of 57.7% before surgery to mean of 14.6% at last follow-up. The slip angle also changed from a mean of 2.4° kyphosis before surgery to a mean of 7.6° lordosis at last follow-up. There were two complications: infection and new radiating pain.
Conclusions
Reduction and posterior interbody fusion using pedicle screw fixation after posterior decompression was a useful surgical method for high-grade spondylolisthesis that corrected lumbosacral kyphosis, filled the structural space of the anterior column, and acheived fusion of interbody movement.
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Fig. 1.
Preoperative plain radiographs (A) and computed tomography scan (B) of a 27-year-old woman show grade IV dysplastic spondylolisthesis at the L5-S1 level. The white arrow indicates the osteophyte in the intervertebral foramen. Plain radiographs obtained just after surgery (C) show correction of anterior slippage and the slip angle. Plain radiographs obtained 4 years after surgery (D) show that reduction and alignment were well maintained.
Fig 2.
Preoperative plain radiographs (A) of a 50-year-old woman show grade III degenerative spondylolisthesis with facet arthritic change at the L5-S1 level. Intraoperative plain radiographs (B) show reduction using a Harrington instrument. Plain radiographs obtained just after surgery (C) show correction of spondylolisthesis. Plain radiographs obtained 9 years after surgery (D) show that reduction and alignment of L5-S1 were well maintained but spondylolisthesis developed at the L4-5 level.
Table 1.
Patient datas of high grade spondylolisthesis
| Number | Age (Yrs) | Gender | Type | Symptom P | VAS (0-10) | ODI (0-50) | Ant. slippage(%) | Slip angle (Degrees)∗ | Satis-faction† | Complication | ||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Pre-op | last f/u | Pre-op | last f/u | Pre-op | last f/u | Pre-op | last f/u | |||||||
| 1 | 52 | F | Isthmic | LBP c radiating pain | 9 | 2 | 36 | 11 | 55 | 13 | 9.8 | 14.5 | 3 | |
| 2 | 51 | F | Isthmic | LBP c radiating pain | 7 | 1 | 29 | 8 | 52 | 12 | −3.6 | 14.3 | 3 | |
| 3 | 27 | F | Dysplastic | Abnormal gait, LBP | 8 | 2 | 32 | 9 | 78 | 12 | −32.0 | −19.0 | 4 | |
| 4 | 64 | M | Isthmic | LBP c radiating pain | 10 | 2 | 41 | 12 | 60 | 15 | −13.3 | 3.8 | 4 | |
| 5 | 38 | F | Dysplastic | Abnormal gait, LBP c radiating pain | 9 | 2 | 37 | 8 | 77 | 32 | 7.0 | 6.0 | 4 | |
| 6 | 73 | M | Isthmic | Abnormal gait, LBP c radiating pain | 10 | 2 | 43 | 13 | 55 | 15 | 12.5 | 28.1 | 4 | |
| 7 | 63 | F | Isthmic | LBP c radiating pain | 9 | 3 | 35 | 8 | 52 | 13 | 5.8 | 17.5 | 3 | |
| 8 | 42 | F | Isthmic | LBP c radiating pain | 9 | 2 | 36 | 9 | 53 | 14 | 6.0 | 14.6 | 3 | |
| 9 | 42 | F | Isthmic | LBP c radiating pain | 9 | 3 | 37 | 8 | 51 | 12 | −12.2 | 6.9 | 3 | |
| 10 | 57 | F | Isthmic | LBP c radiating pain | 8 | 2 | 33 | 8 | 53 | 13 | 1.9 | 2.6 | 3 | |
| 11 | 50 | F | Degenerative | LBP c radiating pain | 10 | 1 | 39 | 13 | 60 | 14 | 3.0 | 11.1 | 4 | |
| 12 | 54 | F | Isthmic | LBP c radiating pain | 9 | 2 | 36 | 10 | 52 | 13 | −5.3 | 3.7 | 2 | New radiating pain |
| 13 | 52 | F | Isthmic | LBP c radiating pain | 9 | 4 | 37 | 16 | 52 | 12 | −10.2 | −5.0 | 1 | Postop. infection |
| Mean | 51.2 | 8.9 | 2.1 | 36.2 | 10.2 | 57.7 | 14.6 | −2.4 | 7.6 | |||||
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