Fusion for treating double-segment lumbar spondylisthesis: follow-up evaluation of lumbar height, pelvic tilt angle and sacral slope angle

doi:10.3969/j.issn.2095-4344.2015.09.012

Abstract

Abstract:

BACKGROUND: Posterior lumbar interbody fusion with pedicle screws has been applied maturely in treating single-level lumbar spondylisthesis. However, little evidence has focused on the application of this operation in treatment of double-segment lumbar spondylolisthesis.
OBJECTIVE: To investigate the clinical efficacy of posterior lumbar interbody fusion with pedicle screws in treatment of double-segment lumbar spondylolisthesis.
METHODS: Twenty patients with double-segment lumbar spondylolisthesis were treated with posterior lumbar interbody fusion with pedicle screws, including posterior lumbar-spinal canal decompression, nerve root release, interbody graft fusion, pedicle screws reduction and fixation. Clinical functional recovery was assessed by Oswestry disability index and visual analog scale. Radiographic data including lumbar slippery percentage, lumbar slippery angle, lumbar height, pelvic tilt angle and sacral slope angle were measured. All data was collected 1 day before surgery, 1 day, 3 months, 6 months and 1 year after surgery, and every year constantly.
RESULTS AND CONCLUSION: All 20 patients were followed up for 6 months to 3 years. Oswestry disability index and visual analog scale were lower after surgery and at the final follow-up, when compared with before surgery (P < 0.05). Lumbar disc height was significantly increased after surgery and at the final follow-up, than those of pre-operation (P < 0.05). Lumbar slippery percentage, pelvic tilt angle and sacral slope angle were improved significantly after surgery and at the final follow-up, when compared with before surgery (P < 0.05). During the follow-up, there were no signs of rupture, loosing or falling in the internal fixation and no pseudarthrosis. Reposition and reliable fusion of the bone graft were achieved satisfactorily in all patients. All patients are satisfactory of posterior operation with pedicle screw internal fixation, reduction, decompression in treating double-segment lumbar spondylolisthesis, due to satisfactory reduction, reliable fixation, high fusion rate and reconstruction of normal sagittal sequence in lumbar spine, which can enhance the stability of lumbar spine.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

全文链接：

Key words: Tissue Engineering, Lumbar Vertebrae, Intervertebral Disk

CLC Number:

R318

Yang Si-zhen, Ma Jin-feng, Wang De-chun. Fusion for treating double-segment lumbar spondylisthesis: follow-up evaluation of lumbar height, pelvic tilt angle and sacral slope angle[J]. Chinese Journal of Tissue Engineering Research, 2015, 19(9): 1382-1387.

Figures/Tables 1

2.1 受试者数量分析患者20例均获得随访，均进入结果分析，无脱失病例。 2.2 受试者随访结果患者20例均完成随访，随访时间为6个月至1年。所有节段均不同程度复位，无内固定松动或断钉、断棒现象，无植骨吸收或假关节形成情况。固定后6个月-1年均可观察到植骨融合，所有患者均达骨性融合。 2.3 固定后患者临床功能恢复情况 20例患者经固定治疗后Oswestry功能障碍指数评分较固定前下降。固定前Oswestry功能障碍指数评分与固定后及末次随访相比，差异均表现出明显显著性意义(P < 0.05)。与Oswestry功能障碍指数评分结果呈现的趋势相似，患者在固定后目测类比评分较固定前下降，固定前与固定后及末次随访目测类比评分相比，差异均有显著性意义(P < 0.05)。见表1。 2.4 固定后患者影像学测量结果固定后及末次随访时椎间隙高度均较固定前增加(P < 0.05)，同时，固定后椎间隙高度与末次随访相比，差异无显著性意义(P > 0.05)。患者接受后路腰椎椎间融合内固定治疗后，固定后及末次随访滑移百分率与固定前滑移百分率相比差异有显著性意义(P < 0.05)。固定后与末次随访滑移百分率相比差异无显著显著性意义。固定后及末次随访腰椎滑脱角与固定前相比差异无显著性意义(P > 0.05)，同时固定后及末次随访相比也未表现出明显统计学差异。患者固定后及末次随访所测的骨盆倾斜角较固定前减小，而骶骨倾斜角较固定前增大(P < 0.05)，而固定后与末次随访相比，二者之间均差异无显著性意义。见表1。 2.5 手术时间变化患者手术时间155-395 min，平均245 min；术中出血量200-2 000 mL，平均955 mL。 2.6 不良反应分析患者1例固定后出现一侧下肢放射痛，考虑为术中神经根牵拉刺激导致，经神经营养药物及止痛药物治疗3 d后疼痛缓解；患者2例手术后出现切口感染，考虑为手术后不洁操作或患者年龄较大愈合较慢导致易感性增加，手术后经切口清创缝合及积极抗感染2周后炎症控制、切口完好愈合。"

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