RESUMO
STUDY DESIGN: This study analyzed the efficacy of the reduction and its maintenance using the posterior pedicular screw system in adult patients undergoing surgical treatment for symptomatic, isthmic spondylolisthesis. OBJECTIVE: To evaluate the effect of the reduction for lumbar isthmic spondylolisthesis in adult. SUMMARY OF LITERATURE REVIEW: If the increase of the shear force is approved as a main biomechanical feature of spondylolisthesis, reduction of the shear forces to the physiologic level must be regarded as the goal of surgical treatment. MATERIALS AND METHODS: 11 cases were treated with posterior monosegmental two point f;cation and posterolateral fusion (Group 1), 8 cases with a combined surgery of posterior monosegmental two point fixation, posterolateral fusion and anterior interbody fusion (Group 2), and 20 cases with posterior two segmental three point fixation and posterolateral fusion (Group 3). We assessed the clinical results and the radiologic objective parameters. RESULTS: The patients were followed up for more than 2 years (mean : 64 months). The satisfactory clinical results were 9 cases (81.8%) in Group 1 ,7 cases (87.5%) in Group 2 and 17 cases (85%) in Group 3. Radiologically, the efficacy of reduction and its maintenance were satisfactory results in Group 2, and the changes of the slip angle and the disc height showed that the loss of correction was greater than postoperative correction, although there were no statistical significant differences in the three groups. CONCLUSION: According to the our results, there was no significant relationship between the clinical result and the rdiological one. However, we think that the correcton of the deformity using the posterior pedicular screw system have some biomechanical advantages and seem to be recommendable for the treatment of isthmic spondylolisthesis in adults.
Assuntos
Adulto , Humanos , Anormalidades Congênitas , EspondilolisteseRESUMO
Potentially, some donor site complications are associated with the harvesting of autogenous tricortical iliac bone grafts for anterior spinal fusion. The purpose of this study was to evaluate the reliability of the anterior iliac crest reconstruction after harvesting autogenous iliac grafts for anterior spinal fusion. We devided into two groups : the study group were the anterior iliac crest reconstruction in 57 patients with minimal twelve months follow up period, the control group were not the anterior iliac crest reconstruction in 21 patients who could not obtain the rib from retroperitoneal approach. The average follow up was obtained at 43.3 months(12 to 72 months) in study group, at 41.6 months(12 to 60 months) in control group. The study group had a tendency to improve the donor site pain after incorporation of the rib graft and the control group tend to remain the donor site pain till late especially in the thinner group and combined disease group. In residual deformity of the donor site, the study group was superior to the control group. Residual deformity of the study group was associated with the complications such as displacement and resorption of the grafts. Cosmetic residual deformity tends to be higher in the thinner group. Radiographically all rib gragts incorporated in situ in 51 patients despite of some cases of migration(Average 11 weeks and 4 days) and clinical results did not affect by biological behavior of rib grafts on the follow up radiogram. The authors attempted anterior iliac crest reconstruction using the implants (Mennen plate in 3 patients, threaded pin in 3 patients) after large harvesting of autogenous tricortical graft in 6 patients who could not obtain the rib from retroperitoneal approach or could not fit the rib too the defect. In those cases the results were satisfactory clinically. These results suggest anterior iliac crest reconstruction can minimize painful deformity after the harvesting of autogenous tricortical iliac grafts for anterior spinal fusion.