Clinical results of posterolateral fusion in treating lumbar low-grade spondylolisthesis / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze the clinical outcomes and losses of correction for posterolateral fusion on low-grade lumbar spondylolisthesis.</p><p><b>METHODS</b>From October 2001 to July 2008, 37 patients with a mean age of 60.1 years (range, 27 - 88 years) with low-grade lumbar spondylolisthesis treated with posterolateral fusion, including 9 males and 28 females, were reviewed retrospectively. The clinical outcomes were evaluated using the visual analogue scale (VAS) and Oswestry disability index (ODI). The fusion status and loss of correction were assessed using plain radiographs and CT.</p><p><b>RESULTS</b>All the 37 patients had got complete follow-up for 14 - 96 months (average 36.4 months); post-operative reduction rate was 76.4%, and 34 patients (91.9%) showed loss of correction with a mean loss rate 5.8% (range, -3.0% - 25.8%). The percentage of slip of pre-operative, post-operative and final follow-up indicated significant difference (P < 0.05)compared with each other; post-operative intervertebral disc height indicated significant difference in comparison with that of pre-operatively and at final follow-up (P < 0.05); lumbar lordosis angle at final follow-up showed significant difference when compared with that of pre-operatively and postoperatively (P < 0.05); VAS and ODI at final follow-up indicated significant difference in contrast to that of pre-operative (P < 0.05). Upon final follow-up, the complications were found in 2 cases who presented degenerative scoliosis at 15 and 17 months after the surgery, in 1 case with cranial adjacent segment retrolisthesis at the 14 months after the surgery, in 1 case with cut-out and breakage of screws at the 24 months after the surgery, and in 1 case with postoperative infection which were cured after debridement.</p><p><b>CONCLUSIONS</b>For mid-term follow-up of low-grade lumbar spondylolisthesis, posterolateral fusion shows loss of correction in most cases, but presents good clinical outcome and fusion rate.</p>

Radiological evaluation of intervertebral angles on short-segment fusion of degenerative lumbar scoliosis / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze the radiological change of intervertebral angles after the short-segment fusion of degenerative lumbar scoliosis.</p><p><b>METHODS</b>From January 2001 to May 2007, 28 patients (mean age 62 years old) with degenerative lumbar scoliosis, including 6 male and 22 female, were reviewed retrospectively. The average vertebra number in the lumbar curve were 4.8, ranging from 3 to 6. All the patients underwent posterior decompressive laminotomy, pedicle screw fixation, and posterolateral fusion. The fusion levels were within the curve in all the cases (mean 3.3 vertebrae), without exceeding the end vertebrae. All the patients took standing lumbar antero-posterior and sagittal radiological images pre and post-surgery and upon follow up. The coronal scoliosis Cobb angle, anterior and sagittal intervertebral angles of upper adjacent segment of proximal fused vertebra were measured. The following aspects were also evaluated such as bone graft fusion and complications.</p><p><b>RESULTS</b>Follow up period of 25-97 months, average 50 months; post-operative scoliosis Cobb angle average correction rate was 33.7%, final follow up average correction loss was 3.7 degrees , pre-operative and final follow up results compared with post-operative indicated significant difference (P < 0.05); final follow-up antero-posterior proximal upper fusion segment intervertebral angle compared with pre-operative and postoperative presenting significant difference (P < 0.05). Upon final follow up, all cases did not present pseudo-arthrosis or internal instrumentation related complications.</p><p><b>CONCLUSION</b>For degenerative lumbar scoliosis, short-segment fusion can produce limited correction on antero-posterior proximal upper fusion segment intervertebral angle and cannot stop its aggravation.</p>