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1.
Rev. bras. ortop ; 57(1): 41-46, Jan.-Feb. 2022. tab, graf
Article in English | LILACS | ID: biblio-1365737

ABSTRACT

Abstract Objective To evaluate the impact of the severity of lumbar degenerative disease (LDD) on sagittal spinopelvic alignment. Methods In total, 130 patients (mean age: 57 years; 75% female) with LDD-associated low-back pain were prospectively included. The severity of the LDD was defined by the following findings on anteroposterior and lateral lumbar spine radiographs: osteophytosis; loss of of height of the intervertebral disc; terminal vertebral plate sclerosis; number of affected segments; deformities; and objective instability. The disease was classified as follows: grade 0-absence of signs of LDD in the lumbar spine; grade I - signs of LDD in up to two segments; grade II - three or more segments involved; grade III - association with scoliosis, spondylolisthesis, or laterolisthesis. Spinopelvic radiographic parameters, including pelvic incidence (PI), lumbar lordosis (LL), discrepancy between the PI and LL (PI-LL), pelvic tilt (PT), and sagittal vertical axis (SVA), were analyzed according to the LDD grades. Results The radiographic parameters differed according to the LDD grades; grade-III patients presented higher SVA (p= 0.001) and PT (p= 0.0005) values, denoting greater anterior inclination of the trunk and pelvic retroversion when compared to grade-0 andgrade-I subjects. In addition, grade-III patients had higher PI-LL values, which indicates loss of PI-related lordosis, than grade-I subjects (p= 0.04). Conclusion Patients with more severe LDD tend to present greater spinopelvic sagittal misalignment compared to patients with a milder disease.


Resumo Objetivo Avaliar o impacto da graduação da doença degenerativa lombar (DDL) sobre o alinhamento sagital espinopélvico. Métodos Ao todo, 130 pacientes (dade média: 57 anos; 75% do sexo feminino) com dor lombar associada a DDL foram prospectivamente incluídos. A gravidade da DDL foi definida pelos seguintes achados nas radiografias anteroposterior e de perfil da coluna lombar: osteofitose; perda de altura do disco intervertebral; esclerose na placa vertebral terminal; número de segmentos afetados; deformidades; e instabilidade objetiva. Os pacientes foram graduados segundo a DDL da seguinte maneira: grau 0-ausência de sinais de DDL na coluna lombar; grau I - sinais de DDL em até dois segmentos; grau II - envolvimento em três ou mais segmentos; grau III - quando associada a escoliose, espondilolistese ou laterolistese. Parâmetros radiográficos espinopélvicos, como incidência pélvica (IP), lordose lombar (LL), discrepância entre a IP e a LL (IP-LL), versão pélvica (VP), e eixo vertical sagital (EVS) foram analisados de acordo com os graus de DDL. Resultados Houve diferença nos parâmetros radiográficos comparando-se os graus de DDL, com os pacientes de grau III apresentando maiores valores de EVS (p= 0,001) e VP (p= 0,0005), o que denota maior inclinação anterior do tronco e maior retroversão pélvica do que os pacientes de graus 0 e I. Pacientes de grau III também apresentaram maiores valores de IP-LL, o que denota perda da lordose relativa ao valor da IP, do que pacientes grau I (p= 0,04). Conclusão Pacientes com DDL mais grave demonstraram uma tendência a maior desalinhamento sagital espinopélvico comparados com pacientes com graus mais leves.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Spine/pathology , Spondylolisthesis , Chronic Disease , Low Back Pain/classification , Low Back Pain/radiotherapy , Back Pain , Spondylosis
2.
Coluna/Columna ; 20(1): 26-29, Jan.-Mar. 2021. tab, graf
Article in English | LILACS | ID: biblio-1154018

ABSTRACT

ABSTRACT Objective: Evaluate the relationship between the incidence of different types of degenerative diseases of the spine and lumbopelvic biomechanics, according to the types of lordosis of Roussouly's classification. Methods: Retrospective study of medical records and results of imaging exams of patients seen at a private hospital in São Paulo. The sagittal alignment of these patients was evaluated by classifying them according to Roussouly into 4 types, based on panoramic radiographs of the spine. These results were correlated with the patient's degenerative diagnosis (Herniated disc, Canal stenosis, Spondylolisthesis, degenerative discopathy and Facet arthrosis). Statistical tests were performed comparing the types of curvature and diagnoses identified. Results: 418 patients were evaluated, 51.4% male and 49.6% female. The vast majority of patients, about 54%, had a diagnosis of herniated lumbar disc. There was a statistically significant difference that showed a predilection for surgical treatment in cases classified as Type I and Type II in the Roussouly classification. There was no statistically significant difference that correlated the types of lumbar lordosis with the diagnosis presented by the patients. Conclusion: There is no statistically significant difference that correlates the type of lumbar lordosis according to Roussouly with lumbar degenerative diseases. In contrast, patients classified as Type 1 and Type 2 by Roussouly underwent a greater number of surgical treatments compared to patients type 3 and 4, with statistical relevance. Level of evidence 2; Retrospective prognostic study.


RESUMO Objetivos: Avaliar a relação da incidência dos diferentes tipos de doenças degenerativas da coluna com a biomecânica lombopélvica, de acordo com os tipos de lordose segundo Roussouly. Métodos: Estudo retrospectivo de prontuários médicos e de resultados de exames de imagens de pacientes atendidos em um hospital privado de São Paulo. Foi avaliado o alinhamento sagital desses pacientes classificando-os de acordo com Roussouly em 4 tipos, com base nas radiografias panorâmicas da coluna vertebral. Esses resultados foram correlacionados com o diagnóstico degenerativo do paciente (Hérnia de disco, Estenose do canal, Espondilolistese, Discopatia degenerativa e Artrose facetaria). Testes estatísticos foram realizados comparando os tipos de curvatura e diagnósticos identificados. Resultados: Foram avaliados 418 pacientes, sendo que 51,4% do sexo masculino e 49,6% do sexo feminino. A grande maioria dos pacientes, cerca de 54%, apresentavam como diagnóstico hérnia de disco lombar. Houve uma diferença estatisticamente significativa que evidenciou uma predileção do tratamento cirúrgico nos casos classificados como Tipo I e Tipo II na classificação de Roussouly. Não houve diferença estatisticamente significativa que correlacionasse os tipos de lordose lombar com o diagnóstico apresentado pelos pacientes. Conclusões: Não houve diferença estatisticamente significativa que correlacione o tipo de lordose lombar de acordo com Roussouly com as doenças degenerativas lombares. Em contrapartida, os pacientes classificados como Tipo 1 e Tipo 2 de Roussouly foram submetidos em maior número ao tratamento cirúrgico em comparação com os pacientes tipo 3 e 4, com relevância estatística. Nível de evidência 2; Estudo prognóstico retrospectivo.


RESUMEN Objetivos: Evaluar la relación entre la incidencia de diferentes tipos de enfermedades degenerativas de la columna y la biomecánica lumbopélvica, según los tipos de lordosis de Roussouly. Métodos: Estudio retrospectivo de registros médicos y resultados de exámenes de imágenes de pacientes atendidos en un hospital privado en São Paulo. La alineación sagital de estos pacientes se evaluó clasificándolos según Roussouly en 4 tipos, en base a radiografías panorámicas de la columna vertebral. Estos resultados se correlacionaron con el diagnóstico degenerativo del paciente (disco herniado, estenosis del canal, espondilolistesis, discopatía degenerativa y artrosis facetaria). Se realizaron pruebas estadísticas comparando los tipos de curvatura y los diagnósticos identificados. Resultados: Se evaluaron 418 pacientes, 51.4% hombres y 49.6% mujeres. La gran mayoría de los pacientes, alrededor del 54%, tenían un diagnóstico de hernia de disco lumbar. Hubo una diferencia estadísticamente significativa que mostró una predilección por el tratamiento quirúrgico en los casos clasificados como Tipo I y Tipo II en la clasificación de Roussouly. No hubo diferencias estadísticamente significativas que correlacionaran los tipos de lordosis lumbar con el diagnóstico presentado por los pacientes. Conclusión: No hubo diferencias estadísticamente significativas que correlacionen el tipo de lordosis lumbar según Roussouly con las enfermedades degenerativas lumbares. En contraste, los pacientes clasificados como Tipo 1 y Tipo 2 por Roussouly se sometieron a un mayor número de tratamientos quirúrgicos en comparación con los pacientes tipo 3 y 4, con relevancia estadística. Nivel de evidencia 2; Estudo de pronostico retrospectivo.


Subject(s)
Humans , Spondylolisthesis , Spondylolysis , Chronic Disease , Low Back Pain , Intervertebral Disc
3.
Article in Chinese | WPRIM | ID: wpr-879438

ABSTRACT

OBJECTIVE@#To explore the relationship between lumbar degenerative spondylolisthesis and T2WI high signal in the interspinous ligament in MRI in order to improve the understanding of the signal changes of the interspinous ligament.@*METHODS@#The clinical data of 43 patients with clinically diagnosed lumbar degenerative spondylolisthesis were collected from March 2018 to March 2020, there were 19 males and 24 females, aged 50 to 92 years with an average of 69 years old. Using picture archiving and communication systems (PACS) to access images and record the distribution and incidence of T2WI high signal in the interspinous ligament between the slipped and non-slipped segments. Using Spearman correlation analysis to explore the relationshipbetween the T2WI high signal of the interspinous ligament and the degree of lumbar spondylolisthesis.@*RESULTS@#Except for 8 ligaments that were not included in the statistical results due to poor image quality, 43 patients with a total of 207 lumbar vertebrae and interspinous ligaments were included in the study. According to the Meyerding classification method, 43 patients had a total of 48 segments with spondylolisthesis, 41 segments in grade Ⅰ and 7 segments in grade Ⅱ. There were 30 cases of MRI T2WI high signal in the interspinous ligament corresponding to spondylolisthesis segment, including 3 cases on L@*CONCLUSION@#In patients with degenerative lumbar spondylolisthesis, the MRI T2WI hyperintensity is more common in the interspinous ligament. The occurrence of T2WI high signal is positively correlated with the degree of spondylolisthesis, which should be payed enough attention in imaging diagnosis.


Subject(s)
Aged , Aged, 80 and over , Female , Humans , Ligaments, Articular , Lumbar Vertebrae/diagnostic imaging , Magnetic Resonance Imaging , Male , Middle Aged , Spondylolisthesis/diagnostic imaging
4.
Article in Chinese | WPRIM | ID: wpr-879399

ABSTRACT

OBJECTIVE@#To investigate the clinical efficacy and advantage of minimally invasive transforaminal lumbar interbody fusion under microscope-assisted Zista channel in the treatment of degreeⅠandⅡdegenerative lumbar spondylolisthesis.@*METHODS@#The clinical data of 18 patients with degenerative lumbar spondylolisthesis treated by microscope-assisted Zista channel MIS-TLIF operation from January 2017 to March 2018 were analyzed retrospectively. There were 10 males and 8 females with an average age of 59 years (48 to 70). The course of spondylolisthesis ranged from 6 months to 5 years with an average of 33 months. The segment of spondylolisthesis was L@*RESULTS@#All the patients completed the operation successfully and were followed up more than 12 months after operation. Operation time was(160.45±34.98) min, intraoperative blood loss was (88.32±21.12) ml, postoperative drainage volume was (50.34 ±18.22)ml, and walking time after operation was (20.65±6.25) h. Preoperative and postoperative at 7 days, 3 months, 12 months, VAS score of low back pain was 7.81±2.16, 4.19±1.17, 2.25±0.62 and 1.53±0.58 respectively, VAS score of leg pain was 8.47± 2.21, 3.45±0.86, 2.31±0.73 and 1.43±0.47, JOA score was 12.01±2.33, 18.56±3.12, 23.54±3.31 and 26.34±2.65. There were significant differences in VAS and JOA scores between preoperative and postoperative (@*CONCLUSION@#MIS-TLIF under microscope-assisted Zista channel has obvious minimally invasive advantages in the treatment of degreeⅠandⅡdegenerative lumbar spondylolisthesis, and it is a safe and effective method.


Subject(s)
Female , Humans , Lumbar Vertebrae/surgery , Male , Middle Aged , Minimally Invasive Surgical Procedures , Retrospective Studies , Spinal Fusion , Spondylolisthesis/surgery , Treatment Outcome
5.
Coluna/Columna ; 19(2): 108-111, Apr.-June 2020. tab
Article in English | LILACS | ID: biblio-1133555

ABSTRACT

ABSTRACT Objective To evaluate the correlation between global sagittal alignment variables and pain improvement after surgery for High-Grade Spondylolisthesis (HGS). Methods A sample with 20 patients with L5-S1 HGS, submitted to arthrodesis with instrumentation from 01/2004 to 12/2016. Patients' demographic data, types of surgeries, complications, sagittal alignment parameters, and Visual Analog Scale (VAS) score (ranging from 0 to 4) were recorded before surgery and at the last follow-up. The data were processed in SPSS 22.0. The confidence level was 0.05. Results The majority of the sample were women, 17 (85%); age at surgery: 52.60 ± 17.15 years; mean follow-up: 3.58 ± 1.62 years; isthmic etiology, 16 (80%) and dysplastic, 4 (20%); Meyerding Grading 3: 12 (60%), Grading 4: 3 (15%) and Grading 5: 5 (25%); SDSG type 4: 6 (30%), type 5a: 3 (15%), 5b: 3 (15%), type 6: 7 (35%) and not classified 1 (5%); surgery: in situ fusion 3 (15%) and reduction 17 (85%); fusion levels: L3-S1: 1 (5%), L3-Iliac: 1 (5%), L4-S1: 1 (5%), L4-Iliac: 6 (30%) and L5-S1: 11 (55%). Comparing the pre- and postoperative parameters, a significant improvement (p <0.05) was seen in the VAS, T1 slope, T1 pelvic angle (TPA), slip angle, Dubousset's lumbosacral angle and slip %. Evaluating the correlation between the variation in sagittal parameters and the improvement in VAS scale, it was found that the TPA showed a strong correlation (r = 0.709, p = 0.032). Conclusions the present study found a strong correlation between the improvement/reduction in TPA values and the reduction in pain intensity in the VAS. Level of evidence IV; Case Series.


RESUMO Objetivo Avaliar a correlação entre as variáveis do alinhamento sagital global e a melhora da dor após a cirurgia de espondilolistese de alto grau (EAG). Métodos Uma amostra com 20 pacientes com espondilolistese de alto grau L5-S1, submetidos à artrodese com instrumentação, de 01/2004 a 12/2016. Os dados demográficos dos pacientes, tipos de cirurgias, complicações, parâmetros do alinhamento sagital e escore da Escala Visual Análoga (EVA) (variando de 0 a 4) foram registrados antes da cirurgia e no último acompanhamento. Os dados foram processados no SPSS 22.0. O nível de confiança foi 0,05. Resultados A maioria da amostra foi composta por mulheres, 17 (85%); idade na cirurgia: 52,60 ± 17,15 anos; tempo médio de acompanhamento: 3,58 ± 1,62 anos; etiologia ístmica, 16 (80 %) e displásica, 4 (20%); Grau Meyerding 3: 12 (60%), Grau 4: 3 (15%) e Grau 5: 5 (25%); SDSG tipo 4: 6 (30%), tipo 5a: 3 (15%), 5b: 3 (15%), tipo 6: 7 (35%) e não classificado 1 (5%); cirurgia: fusão no local 3 (15%) e redução 17 (85%); níveis de fusão: L3-S1, 1 (5%), L3-Ilíaco: 1 (5%), L4-S1: 1 (5%), L4-Ilíaco: 6 (30%) e L5-S1: 11 (55%). Comparando-se os parâmetros pré- e pós-operatório, observou-se uma melhora significativa (p <0,05) na EVA, declive de T1, ângulo T1 pélvico (ATP), ângulo de deslizamento, ângulo lombossacral de Dubousset e % de deslizamento. Avaliando-se a correlação entre a variação dos parâmetros sagitais com a melhora na escala EVA, verificou-se que o ATP apresentou forte correlação (r = 0,709, p= 0,032). Conclusões O presente estudo encontrou uma forte correlação entre a melhora/redução nos valores de ATP e na redução na intensidade da dor na EVA. Nível de evidência IV; Série de casos.


RESUMEN Objetivo Evaluar la correlación entre las variables de la alineación sagital global y la mejora del dolor después de la cirugía para espondilolistesis de alto grado (EAG). Métodos Una muestra con 20 pacientes con espondilolistesis de alto grado L5-S1, sometidos a la artrodesis con instrumentación, de 01/2004 a 12/2016. Los datos demográficos de los pacientes, tipos de cirugías, complicaciones, parámetros de la alineación sagital y puntuación de la Escala Visual Análoga (EVA) (variando de 0 a 4) fueron registrados antes de la cirugía y en el último acompañamiento. Los datos fueron procesados en SPSS 22.0. El nivel de confianza fue de 0,05. Resultados La mayoría de la muestra fue compuesta por mujeres, 17 (85%); edad en la cirugía: 52,60 ± 17,15 años; tiempo promedio de acompañamiento: 3,58 ± 1,62 años; etiología ístmica, 16 (80 %) y displásica, 4 (20%); Grado Meyerding 3: 12 (60%), Grado 4: 3 (15%) y Grado 5: 5 (25%); SDSG tipo 4: 6 (30%), tipo 5a: 3 (15%), 5b: 3 (15%), tipo 6: 7 (35%) y no clasificado 1 (5%); cirugía: fusión en el local 3 (15%) y reducción 17 (85%); niveles de fusión: L3-S1, 1 (5%), L3-Ilíaco: 1 (5%), L4-S1: 1 (5%), L4-Ilíaco: 6 (30%) y L5-S1: 11 (55%). Comparándose los parámetros pre y postoperatorio, se observó una mejora significativa (p <0,05) en la EVA, pendiente de T1, ángulo T1 pélvico (ATP), ángulo de deslizamiento, ángulo lumbosacro de Dubousset y % de deslizamiento. Evaluándose la correlación entre la variación de los parámetros sagitales con la mejora en la escala EVA, se verificó que el ATP presentó fuerte correlación (r = 0,709, p= 0,032). Conclusiones El presente estudio encontró una fuerte correlación entre la mejora/reducción en los valores de ATP y en la reducción en la intensidad del dolor en la EVA. Nivel de evidencia IV; Serie de Casos.


Subject(s)
Humans , Spondylolisthesis , Quality of Life , Spinal Fusion
6.
Rev. cuba. ortop. traumatol ; 34(1): e220, ene.-jun. 2020. ilus
Article in Spanish | LILACS, CUMED | ID: biblio-1139114

ABSTRACT

RESUMEN Se trata de un paciente masculino de 85 años de edad, que sufrió una caída y fue inmovilizado y trasladado al servicio de urgencia; refería dolor cervical y rigidez del cuello. Al examen neurológico no se constata déficit neurológico, salvo la contractura de la musculatura cervical. Se le diagnosticó espondilolistesis traumática del axis grado III confirmada mediante estudios radiográficos. Se le realizó abordaje anterior retrofaríngeo extendido con fijación con láminas y tornillos C2-3. El paciente utilizó ortesis rígida externa durante 4 semanas. Su evolución fue favorable(AU)


ABSTRACT This is an 85-year-old male patient who fell and was immobilized and transferred to the emergency department. He complained of neck pain and neck stiffness. Neurological examination revealed no neurological deficit, except for the contracture of the cervical musculature. Traumatic spondylolisthesis of the axis grade III confirmed by radiographic studies was diagnosed. An extended anterior retropharyngeal approach was performed with fixation with blades and C2-3 screws. The patient wore a rigid external orthosis for 4 weeks. His evolution was favorable(AU)


Subject(s)
Humans , Male , Aged, 80 and over , Spinal Fusion/methods , Axis, Cervical Vertebra/injuries , Spondylolisthesis/surgery , Cervical Vertebrae/injuries
7.
Article in Chinese | WPRIM | ID: wpr-827242

ABSTRACT

OBJECTIVE@#To analyze the characteristics of lumbar spine-pelvic structure in degenerative lumbar spondylolisthesis and its significance in degenerative lumbar spondylolisthesis(DLS).@*METHODS@#The clinical data of 45 patients with simple degenerative L-segment lumbar spondylolisthesis (spondylolisthesis group) admitted from April 2015 to January 2017 were retrospectively analyzed, which were compared with 50 healthy people with complete physical examination data in the same period(control group). Statistical analysis of the lumbar spine-pelvic structure parameters of the subjects through imaging data was performed to analyze the characteristics of the spine-pelvis of DLS patients. The degenerative characteristicsof intervertebral disc and articular process joint were observed in degenerative lumbar spondylolisthesis. Use Spearson to analyze the correlation between observation items.@*RESULTS@#The facet joint angle, lumbar lordosis angle (LL), pelvic incidence angle(PI), pelvic tilt angle (PT), sacral slope angle (SS) in spondylolisthesis group of L-segment were (36.5±11.2)°, (44.2±7.3)°, (66.5±11.6)°, ( 22.2±10.0)°, (33.4±11.3)°, respectively, while in control group were (44.4±8.2)°, (36.7±8.5)°, (55.4± 13.2)°, (14.4±7.0)°, (42.3±13.1)°. PI, LL, PT of spondylolisthesis group were obviously larger than that of control group (< 0.05), the facet joint angle and SS of spondylolisthesis group were smaller than that of control group(<0.05). The correlation analysis showed that PI value was related to the PT and SS in two group. The degree of degeneration of intervertebral disc was related to the degree of spondylolisthesis. The degree of degeneration of L-S intervertebral disc and L facet jointin spondylolisthesis group was more serious (P <0.05).@*CONCLUSION@#Lumbar spinal pelvic structure of degenerative lumbar spondylolisthesis has undergone significant changes. Lumbar lordosis and pelvic dumping phenomenon in the mechanism of lumbar degeneration plays an important role. Lumbar facet joint degeneration and lumbar intervertebral disc degeneration are mutually promoted, and lumbar spondylolisthesis aggravates intervertebral disc and facet joint degeneration.


Subject(s)
Humans , Intervertebral Disc Degeneration , Lumbar Vertebrae , Lumbosacral Region , Pelvis , Retrospective Studies , Spondylolisthesis
8.
Acta ortop. mex ; 33(5): 308-313, sep.-oct. 2019. tab, graf
Article in English | LILACS | ID: biblio-1284962

ABSTRACT

Abstract: Introduction: Changes in ligamentum flavum (LF) related to degeneration are secondary to either the aging process or mechanical instability. Previous studies have indicated that LF with aging shows elastic fiber loss and increased collagen content, loss of elasticity may cause LF to fold into the spinal canal, which may further narrow of the canal. Material and methods: A total of 67 patients operated with the surgical indications of lumbar spinal stenosis (LSS), lumbar disc herniation (LDH) and lumbar degenerative spondylolisthesis (LDS) were included. LF samples were obtained from patients who had LSS (39), LDH (22) and LDS (6). Specimens were examined with regard to chondroid metaplasia, calcification, fragmentation of collagen fibers, cystic degeneration, fibrillar appearence, and hypercellularity. Results: The most frequent histopathological changes were hyalinization and fragmentation of collagen fibers occur in 34%, neovascularization in 40.3% and irregular arrangement of elastic fibers is the most prevalent change with 56.7% of the total samples. There is a difference in the presence of certain changes in the LF according to the diagnosis, being statistically significant for fragmentation of collagen fibers (p = 0.045), cystic degeneration (p = 0.001), fibrillar appearance (p = 0.007) and hypercellularity (p = 0.005) all of these, being more prevalent in LDS group. LHD group presented fragmentation of collagen fibers in 45.5% (p = 0.045) and fibrillar appearance in 4.5% (p = 0.009). Conclusions: There is not evidence of cellular hyperthophy in the histhopatological analyses, thickening of the LF can be seen by bulking of LF followed by collapse of motion segment.


Resumen: Introducción: Los cambios en el ligamento flavum (LF) relacionados con la degeneración son secundarios al proceso de envejecimiento o a la inestabilidad mecánica. Estudios anteriores han indicado que LF con envejecimiento muestra pérdida de fibras elásticas y aumento del contenido de colágeno, la pérdida de elasticidad puede hacer que el LF se pliegue en el canal espinal, disminuyendo su espacio. Material y métodos: Se incluyeron 67 pacientes operados de estenosis lumbar espinal (LSS), hernia de disco lumbar (LDH) y espondilolistesis degenerativa (LDS). Se obtuvieron muestras de LF de pacientes que tenían LSS (39), LDH (22) y LDS (6). Se examinaron especímenes con respecto a metaplasia condroide, calcificación, fragmentación de fibras de colágeno, degeneración quística, apariencia fibrilar e hipercelularidad. Resultados: Los cambios histopatológicos más frecuentes fueron la hialinización y la fragmentación de las fibras de colágeno (34%), neovascularización en 40.3%, y la disposición irregular de las fibras elásticas es el cambio más frecuente con 56.7% del total de muestras. Existe una diferencia en la presencia de cambios en el LF, de acuerdo con el diagnóstico, siendo estadísticamente significativo para la fragmentación de las fibras de colágeno (p = 0.045), la degeneración quística (p = 0.001), la apariencia fibrilar (p = 0.007) y la hipercelularidad (p = 0.005) todos ellos, siendo más frecuentes en el grupo LDS. El grupo LHD presentó fragmentación de las fibras de colágeno en 45.5% (p = 0.045) y la apariencia fibrilar en 4.5% (p = 0.009). Conclusiones: No hay evidencia de hipertrofia celular en los análisis histopatológicos, el engrosamiento del LF se puede ver por abultamiento del mismo, seguido de colapso del segmento de movimiento.


Subject(s)
Humans , Spinal Stenosis/surgery , Spondylolisthesis , Ligamentum Flavum , Hernia
9.
Article in Chinese | WPRIM | ID: wpr-776109

ABSTRACT

OBJECTIVE@#To investigate the advantages of minimally invasive surgery-transforaminal lumbar interbody fusion(MIS-TLIF) under Quadrant channel in the treatment of grade I and II degree degenerative lumbar spondylolisthesis.@*METHODS@#The clinical data of 100 patients with grade I and II degree degenerative lumbar spondylolisthesis treated from March 2014 to March 2017 were retrospectively analyzed. Among them, 50 patients were treated with MIS-TLIF, including 19 males and 31 females, aged from 44 to 73 years old with an average of (49.83±15.46) years old; course of disease from 6 months to 7 years with the mean of (22.18±4.74) months; L₄ slippage was in 30 cases and L₅ slippage was in 20 cases, the slippage vertebral pedicles were intact; according to Meyerding classification, 29 cases of I degree slip and 21 cases of II degree slip. Other 50 patients were treated with open-transforaminal lumbar interbody fusion(OPEN-TLIF), including 23 males and 27 females, aged from 40 to 77 years old with an average of(50.67±14.36) years old; course of disease from 6 months to 10 years with the mean of (20.56±5.37) months; L₄ slippage was in 33 cases and L₅ slippage was in 17 cases, the slippage vertebral pedicles were intact; according to Meyerding classification, 34 cases of I degree slip and 16 cases of II degree slip. The operation time, length of surgical incision, intraoperative blood loss, postoperative drainage, and serum creatine kinase(CK-MM) levels before surgery and 1 day after surgery were observed. Visual analogue scale(VAS), Japanese Orthopedic Association Score (JOA), and Oswestry dysfunction index (ODI) were compared between the two groups before and after surgery. According to the imaging data, the slip rate, intervertebral space height and slip angle of the two groups before and 12 months (last follow-up) were compared. Intervertebral fusion was evaluated according to lumbar X-ray and CT at 6 and 12 months postoperatively. The clinical effect was evaluated according to the MacNab criteria at 12 months after surgery.@*RESULTS@#All the patients were followed up for 12 months. In MIS-TLIF group, operation time, length of surgical incision, intraoperative blood loss, postoperative drainage were (118.48±21.97) min, (3.74±0.74) cm, (148.78±32.32) ml, (84.85±16.37) ml, respectively, CK-MM level was (72.31±9.79) μ/L before surgery and (415.12±25.89) μ/L at the first day after surgery. In OPEN-TLIF group, operation time, length of surgical incision, intraoperative blood loss, postoperative drainage were (115.40±11.94) min, (8.46±0.69) cm, (219.27±48.33) ml, (157.69±31.61) ml, respectively, CK-MM level was (75.48±10.73) μ/L before surgery and (506.69±37.86) μ/L at the first day after surgery. The intraoperative blood loss, postoperative drainage volume, length of surgical incision, and CK-MM level on the first postoperative day were lower in MIS-TLIF group than in OPEN-TLIF group(0.05). There were no significant differences in ODI, VAS, and JOA scores before surgery(>0.05). The ODI, VAS, and JOA scores were significantly improved after surgery(0.05). There was no significant difference in intervertebral fusion between groups at 6 and 12 months after operation(>0.05). According to the MacNab standard, 40 cases got excellent results, 7 good, 3 fair in MIS-TLIF group, and 35 cases got excellent results, 10 good, 5 fair in OPEN-TLIF group. One patient had incision exudation and delayed healing in MIS-TLIF group. And in OPEN-TLIF group, 1 patient had local muscle necrosis on the right side of L₅ and the bacterial culture of the secretions was negative in the different three times and the right internal fixation device was taken out after the second operation completely debridement, and finally obtained delayed healing.@*CONCLUSIONS@#The MIS-TLIF under Quadrant channel has advantage of minimally invasive trauma, less bleeding, faster function recovery and better effect in surgical treatment of grade I and II degree degenerative lumbar spondylolisthesis.


Subject(s)
Adult , Aged , Female , Humans , Lumbar Vertebrae , Male , Middle Aged , Minimally Invasive Surgical Procedures , Retrospective Studies , Spinal Fusion , Spondylolisthesis , Treatment Outcome
10.
Article in Chinese | WPRIM | ID: wpr-776103

ABSTRACT

OBJECTIVE@#To compare the sagittal morphological features of the spine and pelvis between L₅S₁ dysplastic spondylolisthesis and isthmus spondylolisthesis in adolescent.@*METHODS@#Retrospective analysis of 24 cases of adolescent L₅S₁ spondylolisthesis with complete imaging data from May 2002 to December 2016. Those included 8 males and 16 females, aged from 10 to 18 years old with an average of (13.4±2.0) years. Among them, 9 cases were diagnosed as dysplastic spondylolisthesis (dysplasia group) and 15 cases isthmic spondylolisthesis (ischemic group). Radiographic parameters including slippage distance, slippage degree, slippage angle, sagittal vertical axis(SVA), thoracic kyphosis(TK), lumbar lordosis(LL), L₅ incidence(L₅I), pelvic incidence(PI), pelvic tilt(PT), sacral slope(SS), sagittal pelvic thickness(SPT), lumbosacral angle (LSA), sacral table angle (STA) were measured on the spinal lateral X-ray of the standing position. Independent-samples t-test was used in the comparison of each variable between two groups. 0.05).@*CONCLUSIONS@#Significant different from isthmic spondylolisthesis, adolescents with dysplastic spondylolisthesis present a different spino-pelvic sagittal alignment, characterized with trunk forward leaning and pelvic retroversion. In case of sagittal imbalance, early surgical intervention is required to restore a balanced spino-pelvic alignment.


Subject(s)
Adolescent , Child , Female , Humans , Lumbar Vertebrae , Male , Pelvis , Postural Balance , Radiography , Retrospective Studies , Spine , Spondylolisthesis , General Surgery
11.
Article in Chinese | WPRIM | ID: wpr-776094

ABSTRACT

Isthmic spondylolisthesis is a common degenerative disease of the spine and seriously affects people's quality of life. At present, surgical indications for lumbar spondylolisthesis have basically reached consensus. The surgical plan for the disease is mainly isthmus repair, decompression of spinal canal, reduction of spondylolisthesis, and spinal fusion. The principle of treatment is mainly to relieve nerve compression and restore spinal stability, but for each the specific method and degree of implementation of the link still remains controversial. Open surgery can complete decompression, reduction and fusion of severe spondylolisthesis, and rebuild the stability of the spine. However, the surgical trauma is too large. Minimally invasive surgery can reduce the damage of paravertebral soft tissue, reduce intraoperative blood loss, shorten the time of hospitalization and rehabilitation, and reduce the incidence of intraoperative and postoperative complications. Therefore, in recent years, more and more clinicians praise it, but the treatment of severe spondylolisthesis lumbar spondylolisthesis is not effective. This article reviews recent advances in surgical treatment of lumbar spondylolisthesis.


Subject(s)
Decompression, Surgical , Humans , Lumbar Vertebrae , Minimally Invasive Surgical Procedures , Quality of Life , Spinal Fusion , Spondylolisthesis , Treatment Outcome
12.
Article in English | WPRIM | ID: wpr-771643

ABSTRACT

PURPOSE@#To compare the efficacy and safety of recombinant human bone morphogenetic protein (rhBMP) and iliac crest autograft in the fusion treatment of lumbar spondylolisthesis.@*METHODS@#The studies using randomized controlled trials to compare the rhBMP with iliac crest autograft in the treatment of lumbar spondylolisthesis were retrieved from Embase, Pubmed, ProQuest dissertations & theses (PQDT), China national knowledge infrastructure (CNKI), Chinese Biomedical Database, Wanfang Data, Cochrane Library (from March 1998 to March 2018). Postoperative fusion rate, clinical success rate, postoperative intervertebral height, complications, operation time, blood loss and duration of hospitalization were chosen as the outcome indicators. Methodological quality of the trials was critically assessed, and relevant data were extracted. Statistical software Revman 5.3 was used for data-analysis.@*RESULTS@#Eleven articles were included in the meta-analysis. The results showed that, comparing the efficacy of rhBMP with iliac crest autograft, statistical significance was found in the 24-month fusion rate post operation [95% CI (1.38, 24.70), p = 0.02] and operation time [95% CI (-14.22, -2.08), p = 0.008]. There is not sufficient evidence for statistical differences in the remaining indicators.@*CONCLUSION@#The current literature shows rhBMP is a safe and effective grafting material in the treatment of lumbar spondylolisthesis. Further evidence is dependent on the emergence of more randomized controlled trials with higher quality and larger sample sizes in the future.


Subject(s)
Autografts , Bone Morphogenetic Proteins , Databases, Bibliographic , Humans , Ilium , Transplantation , Lumbar Vertebrae , General Surgery , Randomized Controlled Trials as Topic , Recombinant Proteins , Spinal Fusion , Methods , Spondylolisthesis , General Surgery , Time Factors , Treatment Outcome
13.
Asian Spine Journal ; : 960-966, 2019.
Article in English | WPRIM | ID: wpr-785490

ABSTRACT

STUDY DESIGN: Cross-sectional study.PURPOSE: This was carried out to evaluate the benefit of a ‘fulcrum bending position’ compared with the standing position for evaluation of sagittal translation and sagittal rotation in symptomatic patients with spondylolisthesis.OVERVIEW OF LITERATURE: In lumbar X-ray, the standing position is the most common position used in determining abnormalities in lumbar movement. Lack of standardized method is one of the pitfalls in this technique. We hypothesized that the new technique, that is, fulcrum bending position, may reveal a higher translation and rotation in spondylolisthesis patients.METHODS: The extension lumbar radiographs of 36 patients with low-grade spondylolisthesis were included in the analysis and measurement. Sagittal translation and sagittal rotation were measured in both the routine standing position and in our new technique, the fulcrum bending position, which involves taking lateral cross-table images in the supine position wherein the patient lies on a cylindrical pipe to achieve maximum passive back extension by the fulcrum principle.RESULTS: Results of the measurement of sagittal translation in both positions revealed that compared with the extension standing position, the fulcrum bending position achieved a statistically significant increase of 1.57 mm in translation of the vertebra position (95% confidence interval [CI], 0.52–2.61; p=0.004). The measurement of sagittal rotation in both positions revealed that when compared with the extension standing position, the fulcrum bending position achieved a statistically significant increase of 3.47° in the rotation of the vertebra (95% CI, 1.64–5.30; p<0.001).CONCLUSIONS: For evaluation of both sagittal translation and sagittal rotation in symptomatic patients with spondylolisthesis, compared with the extension standing position, the fulcrum bending position can achieve an increased change in magnitude. Our technique, that is, the fulcrum bending position, may offer an alternative method in the detection or exclusion of pathological mobility in patients with spondylolisthesis.


Subject(s)
Cross-Sectional Studies , Humans , Methods , Posture , Spine , Spondylolisthesis , Supine Position
14.
Asian Spine Journal ; : 672-681, 2019.
Article in English | WPRIM | ID: wpr-762959

ABSTRACT

The lumbar foramen is affected by different degenerative diseases, including extraforaminal disc herniation, foraminal stenosis (FS), and degenerative or spondylolytic spondylolisthesis. The purpose of this study was to describe percutaneous stenoscopic lumbar decompression with a paramedian approach (para-PSLD) for foraminal/extraforaminal lesions. All operative procedures were performed using a complete uniportal endoscopic instrument system. The para-PSLD can be easily applied to patients with FS and narrow disc space or facet joint hypertrophy. The anatomical view of a para-PSLD is similar to that of a conventional open surgery and allows for good visualization of the foraminal/extraforaminal areas. We suggest that para-PSLD is an alternative and minimally invasive procedure to treat degenerative lumbar foraminal/extraforaminal stenoses.


Subject(s)
Constriction, Pathologic , Decompression , Humans , Hypertrophy , Ion Transport , Spinal Stenosis , Spondylolisthesis , Surgical Procedures, Operative , Zygapophyseal Joint
15.
Asian Spine Journal ; : 441-449, 2019.
Article in English | WPRIM | ID: wpr-762947

ABSTRACT

STUDY DESIGN: A retrospective case-control study. PURPOSE: To evaluate the effect of nitrous oxide and anesthetic and operative factors associated with severe pain in the early postoperative period after thoracolumbar spine surgery. OVERVIEW OF LITERATURE: Thoracolumbar spine surgery is the most common procedure in spine surgery, and up to 50% of the patients suffer from moderate to severe pain. Nitrous oxide has analgesic, anxiolytic, and anesthetic effects; nevertheless, its benefits for early postoperative pain control and opioid consumption remain to be established. METHODS: The medical records of eligible participants who underwent thoracolumbar spine surgery between July 2016 and February 2017 were reviewed. Enrolment was performed consecutively until reaching 90 patients for the case (severe pain) group (patients with a pain score of >7 out of 10 at least once during the post-anesthesia care unit [PACU] admission), and 90 patients for the control (mild-to-moderate pain) group (patients with a pain score of <7 in every PACU assessment). The data collected comprised patient factors, anesthetic factors, surgical factors, PACU pain score, and PACU pain management. RESULTS: A total of 197 patients underwent thoracolumbar spine surgery with an incidence of early postoperative severe pain of 53.3%. The case-control study revealed no differences in the factors related to pain intensity. A subgroup analysis was performed for failed back surgery syndrome (FBSS), spinal stenosis, and spondylolisthesis. After multivariate analyses, only the age group of 19–65 years and the baseline Oswestry Disability Index (ODI) were found to be significant risk factors for early postoperative severe pain in the PACU (odds ratio [OR], 2.86; 95% confidence interval [CI], 1.32–6.25; OR, 1.03; 95% CI, 1.01–1.05, respectively). CONCLUSIONS: Nitrous oxide, anesthetic agents, and surgical techniques did not affect the early postoperative pain severity. Age under 66 years and the baseline ODI were the significant risk factors for pain intensity during the early postoperative period of the FBSS, spinal stenosis, and spondylolisthesis subgroups.


Subject(s)
Analgesia, Patient-Controlled , Anesthetics , Case-Control Studies , Failed Back Surgery Syndrome , Humans , Incidence , Medical Records , Multivariate Analysis , Nitrous Oxide , Pain Management , Pain, Postoperative , Postoperative Period , Retrospective Studies , Risk Factors , Spinal Stenosis , Spine , Spondylolisthesis
16.
Asian Spine Journal ; : 334-342, 2019.
Article in English | WPRIM | ID: wpr-762917

ABSTRACT

Biportal endoscopic spinal surgery (BESS) is a minimally invasive spinal surgery, which is basically similar to microscopic spinal surgery in terms of the use of floating technique and technically similar to conventional percutaneous endoscopic spinal surgery in terms of the use of endoscopic or arthroscopic instruments. Using two independent portals (viewing and working) and maintaining a certain distance from the bony and neural structures allow closer access to the target lesion through a panoramic view by free handling of the scope and instruments rather than through a fixed view by docking into the Kambin's triangle. Minimally invasive surgery allows for reduced dissection and inevitable muscle injury, preserving stability and reducing risks of restabilization. The purpose of fusion surgery is the same as that of the three surgical techniques stated above. Its wider range of view helps to overcome limitations of conventional endoscopic spinal surgery and to supplement the weak points of microscopic spinal surgery, such as limited working space in a tubular retractor and difficulty in accessing the contralateral area. This technique provides an alternative to unilateral or bilateral decompression of lumbar central spinal stenosis, foraminal stenosis, low-grade spondylolisthesis, and adjacent segment degeneration. Early clinical outcomes are promising despite potential for complications, such as dural tearing and postoperative epidural hematoma, similar to other procedures. Merits of BESS include decreased postoperative infection rate due to continuous irrigation throughout the procedure and decreased need for fusion surgery for one- or two-level lumbar stenosis by wide sublaminar and foraminal decompression with minimal sacrifice of stabilizing structures.


Subject(s)
Arthroscopy , Constriction, Pathologic , Decompression , Endoscopy , Hematoma , Minimally Invasive Surgical Procedures , Spinal Stenosis , Spondylolisthesis , Tears
17.
Article in Korean | WPRIM | ID: wpr-770065

ABSTRACT

The aim of this review was to evaluate minimally invasive lateral lumbar interbody fusion on the latest update. Lumbar interbody fusion was introduced recently. This study performed, a literature review of the indications, clinical outcomes, fusion rate, and complications regarding recently highlighted minimally invasive lateral lumbar interbody fusion. The indications of lateral lumbar interbody fusion are similar to the conventional anterior and posterior interbody fusion in degenerative lumbar diseases. In particular, lateral lumbar interbody fusion is an effective minimally invasive surgery in spinal stenosis, degenerative spondylolisthesis, degenerative adult deformity, degenerative disc disease and adjacent segment disease. In addition, the clinical outcomes and fusion rates of lateral lumbar interbody fusion are similar compared to conventional lumbar fusion. On the other hand, non-specific complications including hip flexor weakness, nerve injury, vascular injury, visceral injury, cage subsidence and pseudohernia have been reported. Lateral lumbar interbody fusion is a very useful minimally invasive surgery because it has advantages over conventional anterior and posterior interbody fusion without many of the disadvantages. Nevertheless, nonspecific complications during lateral lumbar interbody fusion procedure remain a challenge to be improved.


Subject(s)
Adult , Congenital Abnormalities , Hand , Hip , Humans , Minimally Invasive Surgical Procedures , Spinal Stenosis , Spondylolisthesis , Vascular System Injuries
18.
Article in Korean | WPRIM | ID: wpr-786068

ABSTRACT

STUDY DESIGN: Retrospective study of prospectively-collected data.OBJECTIVES: To evaluate the radiological outcomes of direct lateral lumbar interbody fusion (DLIF).SUMMARY OF LITERATURE REVIEW: DLIF, as a minimally invasive spinal surgical procedure, is useful for degenerative spinal diseases. However, few reports have evaluated the clinical and radiological outcomes of DLIF in Korea.MATERIALS AND METHODS: We analyzed 44 patients who underwent DLIF at our hospital from September 2015 to September 2017. Of these patients, 89 segments were included in this study. We measured preoperative and postoperative radiological values including the disc height, central canal area, height of the foramen, and segmental sagittal angle on magnetic resonance imaging. We also measured patients' visual analogue scale (VAS) and Oswestry Disability Index (ODI) scores as clinical parameters.RESULTS: Statistically significant improvements were found in the height of the left and right foramina (20.8% and 25.6%, respectively), the height of the intervertebral discs (86.0% and 84.3%, respectively), the cross-sectional area of the central nervous system (33.1%), lumbar lordosis, and the lumbar segmental angle (2.7° and 8.7°, respectively) after surgery. The VAS and ODI scores also showed significant improvements (65.7% and 67.7%, respectively) when compared with the preoperative level.CONCLUSIONS: DLIF was found to be effective for the treatment of diseases such as foraminal stenosis, degenerative spondylolisthesis, and adjacent segment diseases through indirect neuro-decompression of the bilateral foramina and central vertebrae.


Subject(s)
Animals , Central Nervous System , Constriction, Pathologic , Humans , Intervertebral Disc , Korea , Lordosis , Magnetic Resonance Imaging , Retrospective Studies , Spinal Diseases , Spinal Fusion , Spinal Stenosis , Spine , Spondylolisthesis
19.
Article in Korean | WPRIM | ID: wpr-786061

ABSTRACT

STUDY DESIGN: Review article.OBJECTIVES: To assess the evidence for nonoperative treatment of various degenerative spinal degenerative diseases.SUMMARY OF LITERATURE REVIEW: No study has yet evaluated the evidence for preoperative nonoperative treatment of lumbar spinal diseases.METHODS: The evidence regarding nonoperative treatment for each disease was reviewed through NASS guidelines, and the treatment effect compared to surgical treatment was reviewed through the SPORT series. The efficacy of nonoperative treatment according to disease severity and certain special conditions was investigated through corresponding individual articles.RESULTS: No kind of nonoperative treatment could change the fundamental progression of degenerative spinal disease. The natural course of lumbar disc herniation is favorable regardless of treatment. More than 70% of routine cases improve within 6 weeks. However, it does not take a full 6 weeks to decide whether to perform surgery or not. The evidence for transforaminal epidural steroid injections for short-term pain control is grade A. There is grade B evidence for nonoperative treatment with the goal of mid- to long-term pain control. However, we cannot say that those outcomes are better than the natural course of the disease itself. In cases of radicular weakness, the degree of weakness is correlated with the final outcomes, but it is not evident whether the duration of weakness is correlated with surgical outcomes. Early surgery is usually necessary due to intolerable pain, rather than stable motor weakness. The social cost of herniated discs arises from the loss of patients’ productivity, rather than from direct medical expenses. The natural course of spinal stenosis involves provoked pain and the need for palliative care. Unlike disc herniation, rapid deterioration and marked improvement do not occur. The symptoms of mild to moderate lumbar stenosis are unchanged in 70% of cases, improve in 15%, and worsen in 15%. No study has compared nonoperative treatment with the natural course of the disease. There is no evidence for nonoperative treatment of severe stenosis. Epidural spinal injections are effective for controlling short-term pain. Spontaneous recovery of radicular weakness does not occur, and urgent surgery is necessary in such cases. There is no evidence regarding the natural course and nonoperative treatment of degenerative spondylolisthesis. The working group consensus recommends that it should follow the pattern of nonoperative treatment of spinal stenosis when radicular stenosis symptoms are predominant. Overall, 40%–66% of cases of adult bilateral isthmic spondylolysis progress to symptomatic spondylolisthesis. No studies have investigated nonoperative treatment except physical exercise.CONCLUSIONS: Although short-term symptom amelioration can be achieved by nonoperative treatment, the fundamental progression of the disease is not affected. For conditions excluded from most studies, such as prior spine surgery, cauda equina syndrome, progressive neurological deficit, and uncontrollable severe pain associated with instability, deformity, or vertebral fractures, there were not enough studies to reach informed conclusions. Our review found no evidence regarding nonoperative treatment for such conditions. Furthermore, the treatment methods for each disease are not clearly distinguished from each other, and the techniques used for disc herniation have been applied to other diseases without any evidence.


Subject(s)
Adult , Congenital Abnormalities , Consensus , Constriction, Pathologic , Efficiency , Exercise , Humans , Injections, Spinal , Intervertebral Disc Displacement , Palliative Care , Polyradiculopathy , Spinal Diseases , Spinal Stenosis , Spine , Spondylolisthesis , Spondylolysis , Sports
20.
Article in English | WPRIM | ID: wpr-788791

ABSTRACT

OBJECTIVE: In an aging society, the number of patients with symptomatic degenerative spondylolisthesis (DS) is increasing and there is an emerging need for fusion surgery. However, few studies have compared transforaminal lumbar interbody fusion (TLIF) and lateral lumbar interbody fusion (LLIF) for the treatment of patients with DS. The purpose of this study was to investigate the clinical and radiological outcomes between TLIF and LLIF in DS.METHODS: We enrolled patients with symptomatic DS at L4–5 who underwent TLIF with open pedicle screw fixation (TLIF group, n=41) or minimally invasive LLIF with percutaneous pedicle screw fixation (LLIF group, n=39) and were followed-up for more than one year. Clinical (visual analog scale and Oswestry disability index) and radiological outcomes (spondylolisthesis rate, segmental sagittal angle [SSA], mean disc height [MDH], intervertebral foramen height [FH], cage subsidence, and fusion rate) were assessed. And we assessed the changes in radiological parameters between the postoperative and the last follow-up periods.RESULTS: Preoperative radiological parameters were not significantly different between the two groups. LLIF was significantly superior to TLIF in immediate postoperative radiological results, including reduction of spondylolisthesis rate (3.8% and 7.2%), increase in MDH (13.9 mm and 10.3 mm) and FH (21.9 mm and 19.4 mm), and correction of SSA (18.9° and 15.6°) (p<0.01), and the changes were more stable from the postoperative period to the last follow-up (p<0.01). Cage subsidence was observed significantly less in LLIF (n=6) than TLIF (n=21). Fusion rate was not different between the two groups. The clinical outcomes did not differ significantly at any time point between the two groups. Complications were not statistically significant. However, TLIF showed chronic mechanical problems with screw loosening in four patients and LLIF showed temporary symptoms associated with the surgical approach, such as psoas and ileus muscle symptoms in three and two cases, respectively.CONCLUSION: LLIF was more effective than TLIF for spondylolisthesis reduction, likely due to the higher profile cage and ligamentotactic effect. In addition, LLIF showed mechanical stability of the reduction level by using a cage with a larger footprint. Therefore, LLIF should be considered a surgical option before TLIF for patients with unstable DS.


Subject(s)
Aging , Follow-Up Studies , Humans , Ileus , Minimally Invasive Surgical Procedures , Pedicle Screws , Postoperative Period , Spinal Fusion , Spondylolisthesis
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