ABSTRACT
Objective To evaluate the clinical outcome of anterolateral lumbar interbody fusion (ALLIF) for the treat-ment of degenerative lumbar spondylolisthesis(DLS). Methods All of 53 patients with degenerative spondylolisthesis were en-rolled in this study during January 2014 to January 2016. All patients underwent stand-alone ALLIF with self-locked cage, includ-ing 15 males and 38 females with an average of 57.4±11.2 years old. The surgical level included L3,4(4 cases), L4,5(33 cases) and L5S1(16 cases). The operative time, bleed loss and complications were recorded. Clinical outcome was measured by visual analogue scale (VAS), Oswestry disability index (ODI) and the health questionnaire (SF-36). Radiological measures were slippage, disc height, lumbar lordosis, sagittal diameter and area of dural canal, foraminal height and area, and fusion rate. All the data were sta-tistically analyzed. Results All patients were followed up for at least 24 months. The mean operation time was 64.2 ± 12.5 min-utes, and the mean bleed loss was 72.8 ± 14.3 ml. No serious complications such as vascular or nerve injury occurred during peri operation. VAS for low back pain,VAS for leg pain and ODI were significantly decreased from 6.8 ± 1.5,5.6 ± 2.4 and 58.5％± 18.6％preoperatively to 1.6±1.2, 1.2±1.1 and 18.5％±8.8％at 24 months postoperatively.The SF-36 scores were improved signif-icantly from 56.7 ± 12.8 preoperatively to 79.4 ± 14.3 at 24 months postoperatively. Slippage of patients was reduced significantly from 22.5％± 8.3％preoperatively to 5.7％± 2.3％. Disc height and lumbar lordosis were significantly increased from 6.2 ± 1.6 mm and 46.4°±9.2° preoperatively to 10.5±1.4 mm and 53.2°±11.2° at 24 months postoperatively. Sagittal diameter and cross-section-al area of thecal sac were significantly increased from 11.7±2.2 mm and 78.4±28.6 mm2 preoperatively to 13.8±1.6 mm and 112.5± 23.9 mm2 at 6 months postoperatively. Intervertebral foramina height and area were significantly increased from 15.8 ± 4.3 mm and 136.5±25.6 mm2 preoperatively to 19.2±2.5 mm and 157.6±23.1 mm2 at 6 months postoperatively. At 24 months follow-up, the fusion rate was 100％and the subsidence rate was 10.5％. Conclusion Stand-alone ALLIF could achieve satisfactory clinical re-sults and reduction for DLS. Disc height and lumbar lordosis were restored. Efficient decompression was obtained with significant-ly increased sagittal diameter and cross-sectional area of thecal sac and intervertebral foramina height and area. Stand-alone AL-LIF provides a new surgical strategy for the treatment of DLS.
ABSTRACT
Objective To evaluate the clinical outcomes of K-line(-) ossification of posterior longitudinal ligament (OPLL) between single open-door posterior decompression with instrumented in situ fusion(PDF) and laminoplasty (LMP).Methods From February 2008 to February 2015,38 cases including 30 males and 8 females underwent posterior decompression due to K-line(-) OPLL in our institution.The age ranged from 48 to 76 years,mean 56.3±9.7 years.The OPLL canal occupation ratio ranged from 38.6％ to 72.5％,mean 58.1％± 13.6％.According to surgical procedures,26 cases were in PDF group and 12 cases were in LMP group.The data collected from both groups included complications,C2-C7 Cobb angle and neurologic symptoms evaluated based on the Japanese Orthopedic Association (JOA) score and JOA score recovery rate,and were analyzed with statistics in and between groups.Results All the patients were completed follow up with a mean of 3.6±2.1 years (range,2.5 to 7.0 months).At the final follow-up,the postoperative JOA score was 11.8± 1.9 points on average,improved from preoperative 7.7± 1.6 points (t=3.757,P＜0.05),the mean JOA score recovery rate was 44.2±6.7％in PDF group;and the postoperative JOA score was 9.1 ±2.1 points,improved from preoperative 7.9± 1.5 points (t=1.327,P＜0.05),the mean JOA score recovery rate was 29.5±5.0％ in LMP group.No significant difference was found in preoperative JOA score between the two groups (t=0.365,P＞0.05),however,there were significant differences in the postoperative JOA score (t=3.941,P＜0.05) and JOA score recovery rate (t=6.741,P＜0.05) at the final follow-up.In PDF group,the C2-C7 Cobb angle was 4.1±2.0°,similar with preoperative 3.8±1.6° (t=0.587,P＞0.05).On the contrary,the C2-C7 Cobb angle was-2.1°±1.8°,lower than preoperative 3.9°±1.2° (t=6.824,P＜0.05) in LMP group.Ten cases occurred C5 palsy (PDF:7;LMP:3),and 3 cases occurred wound infection (PDF:2;LMP:1).The complication rate was 34.6％ and 33.3％ (x2=0.003,P＞0.05),respectively.Conclusion Compared with LMP,PDF without correcting cervical alignment for patients with K-line(-) OPLL showed better neurological recovery and clinical efficacy.