Surgical treatment of lumbar spondylolisthesis using short or long segment pedicle screw fixation / 中国组织工程研究

ABSTRACT

BACKGROUND: There are a lot of controversies regarding the choice of short versus long segment pedicle screw fixation for the treatment of isthmic spondylolisthesis and degenerative spondylolisthesis treatment. OBJECTIVE: To investigate clinical efficacy of short versus long segment pedicle screw fixation in treatment of lumbar spondylolisthesis.METHODS: A total of 146 spondylolisthesis patients were included in this study, 36 males and 110 females, aged 22-73 years at a mean of 53 years; disease duration was from 1 to 18 years at a mean of 5 years. These patients were treated with lumbar spinal window-opened decompression or laminectomy decompression, a short or long segment pedicle screw internal fixation, transverse interbody fusion.RESULTS AND CONCLUSION: Among 146 involved patients, 72 cases were treated with four pedicle screw fixation (short segments), while 74 cases with six pedicle screw fixation (long segments). Interbody graft was performed in 101 cases, while intertransverse fusion given in 45 cases. Totally 134 cases were followed up for postoperative 1.5-14 years. According to clinical grading standards of Steffee system, the clinical efficacy was assayed excellent in 74 cases, good in 41 cases, mild in 13 cases and poor in 6 cases, with good rate of 85.8%. 77 cases achieved a complete reduction, including 32 cases using a short segment fixation and 45 cases using a long segment fixation. 69 cases achieved partial reduction, including 40 cases using a short segment fixation and 29 cases using a long segment fixation. Pedicle screws ruptures were found in 13 screws of eight patients undergoing short segment fixation, while no pedicle screw fracture was found in long segment fixation. Choice of short or long segment for the fixation is based on the analysis of spondylolisthesis type, severity, duration of disease, emergence of adjacent segment disc degeneration and instability.