ABSTRACT
Spondylolisthesis is a condition in which a vertebra slips anteriorly in relation to the vertebra below as a results of pars defect or degenerative disease.The slipped segment produces abnormal positioning of the vertebrae in relation to each other along the spinal column that causing back pain and neurologic deficit.There are debates about surgical maneuvers low grade spondylolisthesis [grade 1 and 2 according to meyerding classification] whether to reduce the slipped segment or not, the aim of this study is to determine the short and long term difference in the functional iutcome between these methods. This randomized prospective study consist of 32 patients aged between 42-63 years old [11 males and 21 females] treated for sypmtomatic low grade spondylolisthesis between october 2009 to november 2011 and followed up for 24 months.All patients were randomly divided into two groups: group 1 [15 patients] underwent surgical reduction of the slipped segment, and group 2 [17 patients] who underwent in-situ fusion without reduction.both groups had the same pre and postoperative managment.Early postoperative minor complications uncluding one case in each group had superficial wound infections [6.6% and 5.8% in group 1 and 2 respectively] had dural tear intraoperatively that was repaired during the operation; none of patients has CSF leak postoperatively there were two cases in group 1 [13.3%] and one in group 2 [5.8%] had postoperative transient sciatic pain due to nerve irritaton.Depending on the Oswestry disability index [ODI] there was a significant statistical difference between both groups in the shirt term [p-value=0.004] but there was no significant statstical difference in the long term follow up between them [p-value=0.33] regarding the functional outcome.Surgical treatment of low grade symptomatic spondylolisthesis usualy include neural decompression fixation and fusion; however reduction of the slipped segment is not necessary for these patients as the ultimate outcome is similar to those who underwent in-situ fusion only
ABSTRACT
Modic type I changes/bone edema in the vertebrae are present in 6% of the general population and 35-40% of the low back pain population. It is strongly associated with low back pain. Chronic Low back pain [CLBP] is a leading cause of disability. It occurs in similar proportions in all cultures, interferes with quality of life and work performance, and is the most common reason for medical consultations. A new method of treatment included the use of antibiotic in management of CLBP with Modic type I changes has proved to be effective in some cases. The aim was to test the efficacy of antibiotic treatment in patients with chronic low back pain [>6 months] and Modic type I changes [bone edema]. The study was a randomized clinical trial [RCT] with 71 patients whose only known illness was chronic LBP of greater than 6 months duration occurring after a previous disc herniation and who also had bone edema demonstrated as Modic type I changes in the vertebrae adjacent to the previous herniation. Patients were randomized to either 100 days of antibiotic treatment or placebo and were evaluated at baseline, and end of treatment. Outcome measures: are the disease-specific disability Questionnaire, which is Roland Morris Disability Questionnaire [RMDQ] and lumbar pain. 43 of the 71 original patients were evaluated at baseline and at end of treatment follow-up. The two groups were similar at baseline. The antibiotic group had better improvement on the outcome measures and improvement continued after end of treatment. At baseline, 100 days follow-up the means of the disease specific disability-RMDQ changed: antibiotic 15.5, 12; placebo: 15, 14.8. For Lumbar pain: antibiotics 6.4, 4.8; placebo 6.1, 6.0. The antibiotic protocol in this study was more effective for this group of patients [CLBP associated with Modic changes type I] than placebo in the outcomes