POSTERIOR LUMBAR INTERBODY FUSION FOR DOUBLE-SEGMENTAL BILATERAL ISTHMIC LUMBAR SPONDYLOLISTHESIS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

XINGWenhua ,  HUOHongjun , YANGXuejun , XIAOYulong , ZHAOYan , FUYu , ZHUYong , LIFeng , XINDaqi

Department of Spinal Surgery, the Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot Inner Mongolia, 010030, P. R. China;

Corresponding author：

HUOHongjun, Email: huohongjun456@sina.com

Keywords：

Isthmic lumbar spondylolisthesis; Double segments; Posterior lumbar interbody fusion

DOI：

10.7507/1002-1892.20150321

Video：

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Objective To explore the effectiveness of posterior lumbar interbody fusion in the treatment of double-segmental bilateral isthmic lumbar spondylolisthesis. Methods Between February 2008 and December 2013, 17 patients with double-segmental bilateral isthmic lumbar spondylolisthesis were treated with posterior lumbar interbody fusion. There were 12 males and 5 females, with an age ranged 48-69 years (mean, 55.4 years). The disease duration ranged from 11 months to 17 years (median, 22 months). According to the Meyerding classification, 30 vertebrea were rated as degree I, 3 as degree Ⅱ, and 1 as degree Ⅲ. L_{4, 5} was involved in 14 cases and L_{3, 4} in 3 cases. The preoperative visual analogue scale (VAS) score was 8.6±3.2. Results Cerebrospinal fluid leakage occurred in 2 cases because of intraoperative dural tear; primary healing of incision was obtained, with no operation related complication in the other patients. The patients were followed up 1-6 years (mean, 3.4 years). At last follow-up, VAS score was decreased significantly to 1.1±0.4, showing significant difference when compared with preoperative score (t=7.652, P=0.008). X-ray films showed that slippage vertebral body obtained different degree of reduction, with a complete reduction rate of 85% (29/34) at 1 week after operation. All patients achieved bony union at 6-12 months (mean, 7.4 months). According to the Lenke classification, 13 cases were rated as grade A and 4 cases as grade B. No internal fixation loosening and fracture were observed during the follow-up. Intervertebral disc height was maintained, no loss of spondylolisthesis reduction was found. Conclusion It can obtain satisfactory clinical result to use spinal canal decompression by posterior approach, and screw fixation for posterior fusion in treatment of double-segmental bilateral isthmic lumbar spondylolisthesis. The key points to successful operation include accurate insertion of screw, effective decompression, distraction before reduction, rational use of pulling screws, and interbody fusion.

Citation： XINGWenhua, HUOHongjun, YANGXuejun, XIAOYulong, ZHAOYan, FUYu, ZHUYong, LIFeng, XINDaqi. POSTERIOR LUMBAR INTERBODY FUSION FOR DOUBLE-SEGMENTAL BILATERAL ISTHMIC LUMBAR SPONDYLOLISTHESIS. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(12): 1500-1503. doi: 10.7507/1002-1892.20150321 Copy

1.	邹德威, 海涌, 马华松, 等. 重度腰椎滑脱的治疗. 中华骨科杂志, 1998, 18(5):259-262.
2.	付忠泉, 关宏刚, 曹正霖, 等. 多节段腰椎峡部裂并滑脱的后路融合方式选择. 中外医学研究, 2014, 12(22):120-121.
3.	Blumenthal C, Curran J, Benzel EC, et al. Radiographic predictors of delayed instability following decompression without fusion for degenerative grade Ⅰ lumbar spondylolisthesis. J Neurosurg Spine, 2013, 18(4):340-346.
4.	占道禄, 沈宁江, 林明侠, 等. 椎弓根钉固定联合PLIF手术治疗多节段腰椎滑脱的疗效分析. 实用骨科杂志, 2013, 19(3):193-195.
5.	Kalichman L, Kim DH, Guermazi A, et al. Spondylolysis and spondylolisthesis:prevalence and association with low back pain in the adult community-based population. Spine (Phila Pa 1976), 2009, 34(2):199-205.
6.	Lenke L, Bridwell KH. Adult spondylolisthesis with lysis//Bridwell KH. The texbook of spinal surgery. Philadelphia:Lippcottraven, 1997:1269-1298.
7.	王春, 林永绥, 刘成招, 等. 重度腰椎滑脱症的手术治疗. 中国骨与关节损伤杂志, 2011, 26(1):29-31.
8.	潘剑成, 龚旭, 罗飞. 同种异体骨椎间融合器的研究进展及临床应用现状. 中国修复重建外科杂志, 2015, 29(3):381-385.
9.	龚全, 孔清泉, 李涛, 等. 后路复位技术在重度腰椎滑脱症治疗中的应用. 中国修复重建外科杂志, 2013, 27(4):393-398.
10.	Kasliwal MK, Smith JS, Shaffrey CI, et al. Short-term complications associated with surgery for high-grade spondylolisthesis in adults and pediatric patients:a report from the scoliosis research society morbidity and mortality database. Neurosurgery, 2012, 71(1):109-116.
11.	Schuller S, Charles YP, Steib JP. Sagittal spinopelvic alignment and body mass index in patients with degenerative spondylolisthesis. Eur Spine J, 2011, 20(5):713-719.
12.	Uysal M, Cirei E, Ozalay M, et al. The surgical treatment for a rare case of double-level isthmic spondylolisthesis in L4 and L5 lumbar spine:deeompression, reduetion and fusion. Eur J Orthop Surg Traumatol, 2012, 22(1):21-24.
13.	荆丹峰, 许艺荠, 孙太存, 等. 骨水泥注入中空侧孔椎弓根螺钉内固定骨质疏松性腰椎退变:强化技术要点. 中国组织工程研究, 2014, 18(47):7556-7560.
14.	滕海军, 王亮, 郭志良, 等. Quadrant通道下单切口治疗腰椎滑脱近期疗效观察. 中国修复重建外科杂志, 2010, 24(5):517-520.
15.	刘勇, 刘臻, 朱锋, 等. 成人腰椎峡部裂性滑脱症与退变性滑脱症患者脊柱骨盆矢状面形态学研究. 中国脊柱脊髓杂志, 2013, 23(4):307-311.
16.	黄卫国, 海涌. 退行性腰椎滑脱症与峡部裂性腰椎滑脱症患者的手术疗效比较. 中国骨与关节杂志, 2014, 3(6):460-465.
17.	镐英杰, 于磊, 张岩, 等. Luxo通道下经椎间孔减压椎间植骨融合联合Mantis钉棒系统治疗中重度腰椎滑脱症. 中国修复重建外科杂志, 2014, 28(12):1509-1513.
18.	胡学峰, 田先柱, 任威, 等. 双节段腰椎退行性前滑脱的手术治疗. 中国骨与关节损伤杂志, 2013, 28(1):64-65.

1. 邹德威, 海涌, 马华松, 等. 重度腰椎滑脱的治疗. 中华骨科杂志, 1998, 18(5):259-262.
2. 付忠泉, 关宏刚, 曹正霖, 等. 多节段腰椎峡部裂并滑脱的后路融合方式选择. 中外医学研究, 2014, 12(22):120-121.
3. Blumenthal C, Curran J, Benzel EC, et al. Radiographic predictors of delayed instability following decompression without fusion for degenerative grade Ⅰ lumbar spondylolisthesis. J Neurosurg Spine, 2013, 18(4):340-346.
4. 占道禄, 沈宁江, 林明侠, 等. 椎弓根钉固定联合PLIF手术治疗多节段腰椎滑脱的疗效分析. 实用骨科杂志, 2013, 19(3):193-195.
5. Kalichman L, Kim DH, Guermazi A, et al. Spondylolysis and spondylolisthesis:prevalence and association with low back pain in the adult community-based population. Spine (Phila Pa 1976), 2009, 34(2):199-205.
6. Lenke L, Bridwell KH. Adult spondylolisthesis with lysis//Bridwell KH. The texbook of spinal surgery. Philadelphia:Lippcottraven, 1997:1269-1298.
7. 王春, 林永绥, 刘成招, 等. 重度腰椎滑脱症的手术治疗. 中国骨与关节损伤杂志, 2011, 26(1):29-31.
8. 潘剑成, 龚旭, 罗飞. 同种异体骨椎间融合器的研究进展及临床应用现状. 中国修复重建外科杂志, 2015, 29(3):381-385.
9. 龚全, 孔清泉, 李涛, 等. 后路复位技术在重度腰椎滑脱症治疗中的应用. 中国修复重建外科杂志, 2013, 27(4):393-398.
10. Kasliwal MK, Smith JS, Shaffrey CI, et al. Short-term complications associated with surgery for high-grade spondylolisthesis in adults and pediatric patients:a report from the scoliosis research society morbidity and mortality database. Neurosurgery, 2012, 71(1):109-116.
11. Schuller S, Charles YP, Steib JP. Sagittal spinopelvic alignment and body mass index in patients with degenerative spondylolisthesis. Eur Spine J, 2011, 20(5):713-719.
12. Uysal M, Cirei E, Ozalay M, et al. The surgical treatment for a rare case of double-level isthmic spondylolisthesis in L4 and L5 lumbar spine:deeompression, reduetion and fusion. Eur J Orthop Surg Traumatol, 2012, 22(1):21-24.
13. 荆丹峰, 许艺荠, 孙太存, 等. 骨水泥注入中空侧孔椎弓根螺钉内固定骨质疏松性腰椎退变:强化技术要点. 中国组织工程研究, 2014, 18(47):7556-7560.
14. 滕海军, 王亮, 郭志良, 等. Quadrant通道下单切口治疗腰椎滑脱近期疗效观察. 中国修复重建外科杂志, 2010, 24(5):517-520.
15. 刘勇, 刘臻, 朱锋, 等. 成人腰椎峡部裂性滑脱症与退变性滑脱症患者脊柱骨盆矢状面形态学研究. 中国脊柱脊髓杂志, 2013, 23(4):307-311.
16. 黄卫国, 海涌. 退行性腰椎滑脱症与峡部裂性腰椎滑脱症患者的手术疗效比较. 中国骨与关节杂志, 2014, 3(6):460-465.
17. 镐英杰, 于磊, 张岩, 等. Luxo通道下经椎间孔减压椎间植骨融合联合Mantis钉棒系统治疗中重度腰椎滑脱症. 中国修复重建外科杂志, 2014, 28(12):1509-1513.
18. 胡学峰, 田先柱, 任威, 等. 双节段腰椎退行性前滑脱的手术治疗. 中国骨与关节损伤杂志, 2013, 28(1):64-65.

Chinese Journal of Reparative and Reconstructive Surgery

POSTERIOR LUMBAR INTERBODY FUSION FOR DOUBLE-SEGMENTAL BILATERAL ISTHMIC LUMBAR SPONDYLOLISTHESIS

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