Outcomes of anterior lumbar interbody fusion in low-grade isthmic spondylolisthesis in adults: A continuous series of 65 cases with an average follow-up of 6.6years

Abstract BACKGROUND: Although favorable clinical outcomes have been reported for instrumented lumbar interbody fusion (LIF), adjacent segment degeneration (ASD) has been reported as a long-term complication after LIF. OBJECTIVE: To investigate ASD after instrumented LIF performed at a single level and only for the homogeneous disease of adult low-grade isthmic spondylolisthesis. METHODS: A total of 128 patients who had undergone LIF for the treatment of adult low-grade isthmic spondylolisthesis involving the lower lumbar spine at our institution between February 2001 and December 2004 were retrospectively reviewed by chart review and telephone survey. Of them, 103 patients with a minimum of a 36-month follow-up period were enrolled in this study. The mean age was 48.5 years. The average follow-up period was 59 months. Clinical and radiological data related to segmental lordosis (SL), whole lumbar lordosis, sacral slope, pelvic tilt, pelvic incidence, and L1 axis S1 distance were analyzed to identify significant risk factors for ASD. RESULTS: The overall incidence of ASD was 10.6% (11/103). The incidences of radiographic and symptomatic ASD were 8.7% (9/103) and 1.9% (2/103), respectively. All patients improved clinically and functionally during the follow-up period. Postoperative SL, preoperative SL, whole lumbar lordosis, and L1 axis S1 distance were significant risk factors for ASD. Only SL was a significant risk factor for both the preoperative and postoperative states. CONCLUSION: ASD may occur at a relatively lower incidence in adult low-grade isthmic spondylolisthesis compared with other degenerative lumbar spinal diseases. SL is significantly correlated with ASD, whereas mechanical alterations caused by LIF are less likely to affect the adjacent segment. Restoration of normal SL is important for preventing ASD, and long-term follow-up is necessary.

Download Full-text

Minimally invasive anterior lumbar interbody fusion followed by percutaneous pedicle screw fixation for isthmic spondylolisthesis: minimum 5-year follow-up

The Spine Journal ◽

10.1016/j.spinee.2010.02.022 ◽

2010 ◽

Vol 10 (5) ◽

pp. 404-409 ◽

Cited By ~ 40

Author(s):

Jin-Sung Kim ◽

Won Gyu Choi ◽

Sang-Ho Lee

Keyword(s):

Minimally Invasive ◽

Interbody Fusion ◽

Screw Fixation ◽

Pedicle Screw Fixation ◽

Anterior Lumbar Interbody Fusion ◽

Lumbar Interbody Fusion ◽

Isthmic Spondylolisthesis ◽

Percutaneous Pedicle Screw ◽

Percutaneous Pedicle Screw Fixation

Download Full-text

Functional and radiological analysis of posterior lumbar interbody fusion in spondylolisthesis

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20160342 ◽

2015 ◽

Vol 1 (1) ◽

pp. 11

Author(s):

Ramanujam Muthu Manickam ◽

Ganesan G. Ram ◽

S. Sundar ◽

A. Prakash

Keyword(s):

Pedicle Screw ◽

Interbody Fusion ◽

Surgical Intervention ◽

Degenerative Spondylolisthesis ◽

Posterior Lumbar Interbody Fusion ◽

Low Grade ◽

Lumbar Interbody Fusion ◽

Isthmic Spondylolisthesis ◽

The Mean

Background:Spondylolisthesis is present in 5% of the adult population with clinical evidence of low back pain. These patients are treated initially by conservative measures, failing of which surgical intervention is mandatory. Majority of patients with varying degree of slip and disability ultimately require surgical intervention. In this study we are trying to analyse the functional outcome following posterior lumbar interbody fusion in spondylolisthesis.Methods: Posterior lumbar interbody fusion using pedicle screw and rods with cage was performed on 25 patients. 6 months follow-up was completed in 25 patients who were then reviewed at regular intervals. Out of the 25 patients, 17(68%) were females and 8(32%) were males. The mean age of the patients was 40.64 years. Out of 25 patients, 14 patients had listhesis at L4 – L5 level and another 11 at L5 – S1 level. 21(84%) were Isthmic variant and 4 (16%) were Degenerative spondylolisthesis.Results:The mean follow up period in this study of 25 patients is 19 months. Out of 25 patients, there was mean improvement of 18.96 in the Oswestry scoring index. The Visual analogue scale score showed a mean improvement of 6.48. Radiologically, the percentage of slip was decreased by a mean of 8.40%. One patient had a cage extrusion with no neurological deficit.Conclusions:The pedicle screw with rod and cage system is easy to use and provides the anatomic restoration of the isthmus in isthmic spondylolisthesis or restoring the stability after laminectomy/discectomy in degenerative spondylolisthesis. From our study, we strongly believe that this technique is very useful in low grade degenerative and isthmic spondylolisthesis.

Download Full-text

Posterior lumbar interbody fusion versus posterolateral fusion with instrumentation in the treatment of low-grade isthmic spondylolisthesis: midterm clinical outcomes

Journal of Neurosurgery Spine ◽

10.3171/2010.11.spine10281 ◽

2011 ◽

Vol 14 (4) ◽

pp. 488-496 ◽

Cited By ~ 42

Author(s):

Ahmet Murat Müslüman ◽

Adem Yılmaz ◽

Tufan Cansever ◽

Halit Çavuşoğlu ◽

İbrahim Çolak ◽

...

Keyword(s):

Clinical Outcomes ◽

Interbody Fusion ◽

Posterior Lumbar Interbody Fusion ◽

Posterolateral Fusion ◽

Low Grade ◽

Lumbar Interbody Fusion ◽

Isthmic Spondylolisthesis ◽

Transpedicular Instrumentation ◽

Lumbar Spondylolisthesis

Object The purpose of this study was to compare the methods of posterior lumbar interbody fusion (PLIF) and posterolateral fusion (PLF) in cases of isthmic Grades 1 and 2 lumbar spondylolisthesis, and to evaluate the clinical efficacy of the procedures. Methods Operations were performed in 50 patients with lumbar spondylolisthesis in the authors' clinics between 2001 and 2007. Indications for surgery were low-back pain with or without sciatica and neurogenic claudication that had not improved after at least 6 months of conservative treatment. The study included 33 female and 17 male patients, with mean ages of 50.6 years in the PLIF group and 47.3 years in the PLF group. These patients were randomly allocated into 2 groups: decompression, posterior transpedicular instrumentation, and PLF (Group 1; 25 patients) and decompression, posterior transpedicular instrumentation, and PLIF (Group 2; 25 patients). In the PLIF group, titanium cages were used, and autograft material was obtained from the decompression. In the PLF group, bone fragments collected from the iliac crest were used as autografts. A minimum 18-month follow-up was available in all patients. For clinical evaluation, a visual analog scale, Oswestry Disability Index, and the 36-Item Short Form Health Survey were used. Improvements in pre- and postoperative spondylolisthesis, segmental angles, fusion ratios, and postoperative complications were evaluated radiologically. Results The average follow-up period was 3.3 years. Based on the etiologies, isthmic spondylolisthesis was detected in all patients. The spondylolisthesis levels in the patients who underwent PLIF were located at L3–4 (5 patients, 20%); L4–5 (14, 56%); and L5–S1 (6, 24%), whereas the levels in the ones treated with PLF were located at L3–4 (4 patients, 16%); L4–5 (13, 52%); and L5–S1 (8, 32%). In the clinical evaluations, good or excellent results were obtained in 22 (88%) cases in the PLIF group and 19 (76%) cases in the PLF group. Fusion ratios were 100% in the PLIF group and 84% in the PLF group. Both lumbar lordosis and the segmental angle showed greater improvement in the PLIF group. There was no difference in the complication rates for each group. Conclusions Based on early clinical outcomes and the fusion ratios of adult isthmic spondylolisthesis, the authors found PLIF to be superior to PLF.

Download Full-text