Radiographic evaluation of posterolateral lumbar fusion for degenerative spondylolisthesis: long-term follow-up of more than 10 years vs. midterm follow-up of 2–5 years

Although posterolateral fusion of the lumbar spine without instrumentation has been widely performed for spinal instability caused by degenerative spondylolisthesis in the lumbar spine, few long-term follow-up studies have been reported. We studied ten patients who underwent posterolateral fusion for degenerative spondylolisthesis in the lumbar spine without instrumentation in our hospital, five of whom were followed up for more than 10 years and the other five for 2–5 years. We used radiography to examine their fusion status, instability and degenerative changes at the fusion level, change in the slip, change in lumbar lordosis, and instability and degenerative changes one level above and one level below the fusion. In most of the ten patients, radiographic evaluation demonstrated solid fusion, minimal degenerative changes, and preservation of lumbar lordosis and spinal mobility. Posterolateral lumbar fusion for degenerative spondylolisthesis in the lumbar spine seems promising for obtaining not only good radiographic features but also good clinical results lasting over more than 10 years. Electronic Publication     

Posterolateral lumbar fusion

Lumbar fusion has been applied to patients with lumbar instability due to structural defects or regressive degeneration. There are several methods for obtaining spinal fusion, but the gold standard is posterolateral fusion. This type of spinal fusion, which involves placing a bone graft in the posterolateral portion of the spine, has a long history and is considered by many surgeons to be a safe, effective method. We also have performed posterolateral lumbar fusion in patients with lumbar degenerative disease since 1971 and have reported good long-term results at 10 and 20 years after surgery. Posterolateral lumbar fusion, an established method of lumbar fusion with less effect on adjacent segments, is expected to show long-term clinical success. A combination of spinal instruments should be employed for limited purposes, such as correcting spondylolisthesis.Presented at the 76th Annual Meeting of the Japanese Orthopaedic Association, Kanazawa, Japan, May 24, 2003     

The influence of lumbar lordosis on spinal fusion and functional outcome after posterolateral spinal fusion with and without pedicle screw instrumentation

The aim of the current study was to examine the correlation between lumbar lordosis, spinal fusion, and functional outcome in patients suffering from severe low back pain, treated by posterolateral spinal fusion with or without pedicle screw instrumentation. One hundred thirty patients were randomly allocated to posterolateral lumbar fusion with or without Cotrel-Dubousset instrumentation. Functional outcome was assessed preoperatively, and 1 and 2 years postoperatively. Lordosis angles of the lumbar spine and fusion rates were assessed at the 1- and 2-year follow-up. No difference in lordosis angle was found between the two groups at any time. Lordosis was unchanged at 2 years compared with preoperative status in both groups. In the instrumented group, nonunion (23%) was followed by a decrease in lordosis at follow-up (p < 0.05). However, in the noninstrumented group, nonunion (14%) resulted in increased lordosis (p < 0.05). No correlation was found between functional outcome and lordosis angle. The current study showed no correlation between functional outcome and lordosis angle either before or after posterolateral spinal fusion. Use of instrumentation did not influence lumbar spinal alignment compared with noninstrumented fusions. The sagittal alignment was stable both 1 and 2 years after solid fusion. The failure mode of instrumented fusions was a reduced degree of lordosis in contrast to an increased degree of lordosis in patients with noninstrumented fusion.     

Translamino-pedicular screw fixation with bone grafting for symptomatic isthmic lumbar spondylolysis.

Anterior or posterolateral spondylodesis has been reported and used widely as a surgical treatment for lumbar spondylolysis or spondylolisthesis. Although spinal fusion is necessary when there is extensive vertebral slippage or spinal instability, the direct repair of the defect is thought to be anatomical, logical, and less invasive as a surgical treatment for symptomatic lumbar spondylolysis or a minimal degree of spondylolisthesis. This operation, with a few modifications, has been performed since 1985 in our clinic. The results, using Henderson's criteria, were excellent in 64.5% and good in 25.8% of the patients thus treated. For younger patients with symptomatic lumbar spondylolysis, direct repair of the defect using translamino-pedicular instrumentation with bone grafting is recommended, as degenerative changes have not usually occurred in the vertebral discs.     

Factors influencing the long-term outcomes of instrumentation surgery for degenerative lumbar spondylolisthesis: a post-hoc analysis of a prospective randomized study

BACKGROUND CONTEXTLumbar spinal canal stenosis caused by degenerative lumbar spondylolisthesis is one of the most common indications for spinal surgery. However, the factors that influence its long-term (>10 years) outcomes remain unknown.DESIGNThis is a post-hoc analysis of a prospective randomized study.PURPOSEThis study aimed to determine factors that influence the long-term outcomes of instrumentation surgery for lumbar spinal canal stenosis due to degenerative lumbar spondylolisthesis.PATIENT SAMPLEPatients aged ≤75 years with single L4/5 level lumbar canal stenosis caused by degenerative lumbar spondylolisthesis prospectively underwent instrumentation surgery at two hospitals between May 1, 2003, and April 30, 2012; the final follow-up examination was on May 20, 2021.OUTCOME MEASURESThe following data were collected: modified Japanese Orthopedic Association (JOA) score, JOA score recovery rate, visual analog scale (VAS) score for lower back and leg pain, and scores from eight short-form 36 (SF-36) subscales preoperatively and at the final follow-up examination.METHODSSpearman's correlation analysis and univariate and multivariate regression analyses were used to examine preoperative factors that affect the JOA score recovery rate in patients who underwent instrumentation surgery for lumbar spinal canal stenosis at the L4/5 level due to degenerative lumbar spondylolisthesis.RESULTSA total of 42 patients who underwent instrumentation surgery for degenerative lumbar spondylolisthesis and had a long-term follow-up period were included. Of these, 25 and 17 underwent posterolateral fusion and Graf stabilization, respectively. The mean postoperative follow-up duration was 12.5 years. Spearman's correlation analysis revealed that the long-term recovery rate was correlated with the preoperative VAS score for low back pain. In the univariate regression analysis, sex, preoperative VAS score for low back pain, and the SF-36 general health score were significantly associated with the long-term recovery rate. Meanwhile, the multiple stepwise regression analysis identified the preoperative VAS score for low back pain as an independent predictor of the long-term recovery rate.CONCLUSIONSThis study identified the preoperative VAS score for low back pain as an independent predictor of the long-term recovery rate following instrumentation surgery for degenerative lumbar spondylolisthesis. Therefore, when performing posterolateral fusion or Graf stabilization for degenerative lumbar spondylolisthesis, attention should be paid to the intensity of preoperative low back pain and considerations should be given to whether these procedures can improve the patient's symptoms in the long term.     

Techniques of internal fixation for degenerative conditions of the lumbar spine

The indications and techniques for internal fixation of the lumbar spine in degenerative conditions have changed drastically since internal fixation was first applied to the spine almost 100 years ago. Anterior instrumentation and fusion may be used for repair of pseudarthrosis after posterolateral fusion; symptomatic lumbar scoliosis associated with degenerative disc disease; late pain secondary to posttraumatic kyphosis; postlaminectomy instability; and lumbar pain secondary to thoracolumbar kyphosis. Posterior instrumentation and fusion has been performed with Luque instrumentation over 3-4 levels in cases of multilevel instability. Combined anterior and posterior instrumentation and fusion are required for lumbosacral fusion in lumbar scoliosis with degenerative disease, and surgical correction of postsurgical lumbar kyphosis (flat-back syndrome). The techniques are demanding but with attention to detail can be performed with acceptably low-complication rates.     

Mid-term clinical results of Graf stabilization for lumbar degenerative pathologies. a minimum 2-year follow-up.

BACKGROUND CONTEXT: Spinal fusion has some adverse effects, such as nonunion and pain at the site of grafted bone, and fusion with rigid spinal instrumentation especially may have the possibility of increasing mechanical stress on the segments adjacent to the site of fusion. The theory of the Graf system is that it will decrease adjacent disc deterioration because of maintenance of regional lordosis with flexibility and restriction of the motion of unstable segments without rigid spinal fusion. PURPOSE: To assess the clinical and radiologic results of Graf stabilization for lumbar degenerative disorders with minimal or mild instability. STUDY DESIGN: This is a retrospective study examining the mid-term results of Graf stabilization. PATIENT SAMPLE: In total, 59 patients underwent Graf ligamentoplasty and adequate decompression from April 1993 to September 1997. The subjects were 30 men and 29 women, and the mean age at the time of surgery was 60.6 years, ranging from 23 to 82 years. The average follow-up period was 3 years and 5 months, ranging from 2 years to 5 years and 10 months. OUTCOME MEASURES: We evaluated the surgical results using a scoring system, a visual analog scale, and radiological measurements. METHODS: The results were assessed according to a clinical scoring system established by the Japanese Orthopaedic Association (JOA score) and ratings based on a visual analog scale. Through analysis of x-ray images, the sagittal alignment (regional lordosis) and the range of motion (ROM) of the stabilized segments were measured in all cases, and the percentage of segments slipping and posterior disc height were determined for 29 patients with degenerative spondylolisthesis. RESULTS: Clinical scores and low back pain ratings based on a visual analog scale were significantly improved at the time of final follow-up compared with the preoperative values. Regional alignment of the operative segments was maintained in lordosis at the time of final follow-up. Preoperative ROM was significantly reduced at the time of final follow-up. There were no statistical differences in percentage of slippage or percentage of posterior disc height between the final follow-up values and the preoperative values. CONCLUSIONS: Our clinical results indicate that the Graf system is a suitable treatment option for mild and early lumbar degenerative diseases with minimum flexion instability of less than 10 degrees.     

A 2-year follow-up pilot study evaluating the safety and efficacy of op-1 putty (rhbmp-7) as an adjunct to iliac crest autograft in posterolateral lumbar fusions

The ability of bone morphogenetic proteins (BMPs) to induce bone formation has led to a multitude of investigations into their use as bone graft substitutes in spinal surgery. The purpose of this multi-center clinical pilot study was to evaluate the safety and efficacy of BMP-7 (osteogenic protein 1, OP-1), in the form of a putty, combined with autograft for intertransverse process fusion of the lumbar spine in patients with symptomatic spinal stenosis and degenerative spondylolisthesis following spinal decompression. Twelve patients with spinal stenosis and degenerative lumbar spondylolisthesis underwent a laminectomy and partial or complete medial facetectomy as required for decompression of the neural elements, followed by an intertransverse process fusion by placing iliac crest autograft and OP-1 putty between the decorticated transverse processes. No instrumentation was used. Patients were followed clinically using the Oswestry scale and SF-36 outcome forms, and radiographically using static and dynamic radiographs to assess their fusion status over a 2-year period. Independent and blinded radiologists assessed the films for the presence of bridging bone between the transverse processes and measured translation and angulation on dynamic films using digital calipers. Radiographic outcome was compared to a historical control (autograft alone fusion without instrumentation for the treatment of degenerative spondylolisthesis). All adverse events were recorded prospectively. The results showed eight of the nine evaluable patients (89%) obtained at least a 20% improvement in their preoperative Oswestry score, while five of ten patients (50%) with radiographic follow-up achieved a solid fusion by the criteria used in this study. Bridging bone on the anteroposterior film was observed in seven of the ten patients (70%). No systemic toxicity, ectopic bone formation, recurrent stenosis or other adverse events related to the OP-1 putty implant were observed. A successful fusion was observed in slightly over half the patients in this study, using stringent criteria without adjunctive spinal instrumentation. This study did not demonstrate the statistical superiority of OP-1 combined with autograft over an autograft alone historical control, in which the fusion rate was 45%. There were no adverse events related to the OP-1 putty implant in this study, which supports findings in other studies suggesting the safety of bone morphogenetic proteins in spinal surgery.     

Telamon融合技术在下腰椎不稳治疗中的作用

目的回顾性分析了Telamon融合技术在治疗下腰椎不稳定方面的作用。方法本组共68例，均为单节段病变，平均年龄49岁，腰椎椎弓崩裂伴滑脱者27例，腰椎退变性不稳者41例，术前病程平均28．6月，Oswestry残疾指数平均48．5%。所有病例均行后路减压、椎弓根螺钉内固定及Telamon椎体间融合术，其中全椎板切除者5例，双侧椎板间扩大开窗者63例。结果术后随访平均11．8个月，最后随访时Oswestry残疾指数平均7．5％，复查X线片均获良好的骨性融合，无明显不稳定征象。结论Telamon融合技术能提供良好的骨性融合并维持良好的椎体间高度和腰椎的生理性前凸，由于其本身并不具有即刻稳定性，故应在坚强内固定的保护下应用，获得良好效果的关键在于正确的手术适应证。     

How to stabilize a single level lesion of degenerative lumbar spondylolisthesis

The purpose of this study was to compare the success rate of bony fusion and the clinical results of rigid instrumentation, nonrigid instrumentation, and no instrumentation for a single level lesion for degenerative lumbar spondylolisthesis. Thirty-three patients with degenerative spondylolisthesis of L4 who had undergone posterior decompression and posterolateral fusion with autogenous bone graft that included the facet joints had a single level stabilization with a newly designed syndesmoplasty using Leeds-Keio artificial ligaments (Group Leeds-Keio-nonrigid). Thirty-four patients with degenerative spondylolisthesis of L4 who had the same procedure were stabilized with the Steffee system (Group Steffee-rigid). Thirty-five patients who had the same decompression and bony fusion without instrumentation (Group Noninstrumented) were compared with the former two groups. Clinical results were correlated with the stage of bony fusion. The Steffee system was reliable for stabilizing intervertebral angular instability such as a preoperative intervertebral angle difference of more than 11 degrees in flexion and extension. In the patients who preoperatively had an angle difference of less than 10 degrees, no significant difference was seen between Group Leeds-Keio and Group Steffee. The authors concluded that nonrigid instrumentation can be used to achieve successful bony fusion in patients with degenerative spondylolisthesis, who have a preoperative angle difference less than 10 degrees, with excellent clinical results.     

Spondylolisthesis of the thoracic spine. Case report

The thoracic spine is stabilized in the anteroposterior direction by the rib cage and the facet joints. Spondylolisthesis of the thoracic spine is less common than that of the lumbar spine. The authors describe a rare case of thoracic spondylolisthesis in which the patient suffered back pain and myelopathy. The patient was a 44-year-old woman. Plain radiography revealed Grade I T11-12 spondylolisthesis. The pedicle-facet joint angle at T-11 was 118 degrees, greater than that of T-10 or T-12. Postmyelography computerized tomography scanning revealed posterior compression of the dural sac as well as enlargement of and degenerative changes in the facet joint at T-11. Magnetic resonance imaging showed anterior and posterior compression of the spinal cord at the level of the spondylolisthesis. To achieve posterior T10-12 decompression, the surgeons performed a laminectomy and posterolateral fusion in which a pedicle screw fixation system was placed. The patient's back pain disappeared immediately after the operation. The authors conclude that the enlargement of the pedicle-facet joint angle and the degenerative changes of the facet joint caused the thoracolumbar spondylolisthesis.     

High failure rate of the interspinous distraction device (X-Stop) for the treatment of lumbar spinal stenosis caused by degenerative spondylolisthesis

The X-Stop interspinous distraction device has shown to be an attractive alternative to conventional surgical procedures in the treatment of symptomatic degenerative lumbar spinal stenosis. However, the effectiveness of the X-Stop in symptomatic degenerative lumbar spinal stenosis caused by degenerative spondylolisthesis is not known. A cohort of 12 consecutive patients with symptomatic lumbar spinal stenosis caused by degenerative spondylolisthesis were treated with the X-Stop interspinous distraction device. All patients had low back pain, neurogenic claudication and radiculopathy. Pre-operative radiographs revealed an average slip of 19.6%. MRI of the lumbosacral spine showed a severe stenosis. In ten patients, the X-Stop was placed at the L4–5 level, whereas two patients were treated at both, L3–4 and L4–5 level. The mean follow-up was 30.3 months. In eight patients a complete relief of symptoms was observed post-operatively, whereas the remaining 4 patients experienced no relief of symptoms. Recurrence of pain, neurogenic claudication, and worsening of neurological symptoms was observed in three patients within 24 months. Post-operative radiographs and MRI did not show any changes in the percentage of slip or spinal dimensions. Finally, secondary surgical treatment by decompression with posterolateral fusion was performed in seven patients (58%) within 24 months. In conclusion, the X-Stop interspinous distraction device showed an extremely high failure rate, defined as surgical re-intervention, after short term follow-up in patients with spinal stenosis caused by degenerative spondylolisthesis. We do not recommend the X-Stop for the treatment of spinal stenosis complicating degenerative spondylolisthesis.     

Comparison of spinous process–splitting laminectomy versus posterolateral fusion for lumbar degenerative spondylolisthesis

Background

Although several studies have recently shown that spinous process–splitting laminectomy (SPSL) maintains lumbar spinal stability by preserving posterior ligament components and paraspinal muscles as compared with conventional laminectomy, evidence is scarce on the treatment outcomes of SPSL limited to lumbar degenerative spondylolisthesis. We herein compare the surgical results and global alignment changes for SPSL versus posterolateral lumbar fusion (PLF) without instrumentation for lumbar degenerative spondylolisthesis.

Methods

A total of 110 patients with Grade 1 lumbar degenerative spondylolisthesis who had undergone SPSL (47 patients) or PLF (63 patients) with minimum 1-year follow-up were retrospectively enrolled from a single institutional database.

Results

Mean operating time per intervertebral level and intraoperative blood loss per intervertebral level were comparable between the SPSL group and PLF group. Japanese Orthopaedic Association scores, Oswestry disability index, and visual analog scale scores were significantly and comparably improved at 1 year postoperatively in both groups as compared with preoperative levels. The numbers of vertebrae with slip progression to Grade 2 and slip progression of 5% or more at 1 year postoperatively were similar between the groups. In the SPSL group, mean pelvic tilt (PT) was significantly decreased at 1 year postoperatively. In the PLF group, mean lumbar lordosis (LL) was significantly increased, while mean sagittal vertical axis, PT, and pelvic incidence–LL were significantly decreased at 1 year after surgery.

Conclusions

Compared with PLF without instrumentation, SPSL for Grade 1 lumbar degenerative spondylolisthesis displayed comparable results for slip progression and clinical outcomes at 1 year postoperatively.

     

Analysis of sagittal lumbar alignment before and after posterior instrumentation: Risk factor for adjacent unfused segment

The sagittal plane alignment of the degenerative lumbar spine before and after posterior spinal instrumentation surgery was retrospectively studied by radiographic analysis to evaluate the risk factor for adjacent unfused segments. One hundred and thirty-six patients were studied radiographically. The minimum follow-up period was three years. Lordotic angles were obtained from L1 to L5 and from L1 to S1. Lordotic values before and after posterior instrumentation surgery were compared, and degenerative changes in the adjacent unfused segments were analyzed. Significant degenerative changes in the adjacent unfused segments occurred in 21 cases (15.4%). The mean lordotic angles were decreased by approximately 10° after surgery in patients with postoperative changes in the adjacent unfused segment. Conversely, these angles were slightly increased in patients without adjacent segmental changes. These differences in postoperative changes in the angle of lordosis between patients with and without degenerative changes of the adjacent unfused segment were significant (p < 0.01). Loss of lordosis after posterior spinal instrumentation surgery is a significant risk factor for degenerative changes in the adjacent unfused segments.     

Lumbar Lordosis of Spinal Stenosis Patients during Intraoperative Prone Positioning

Background

To evaluate the effect of spondylolisthesis on lumbar lordosis on the OSI (Jackson; Orthopaedic Systems Inc.) frame. Restoration of lumbar lordosis is important for maintaining sagittal balance. Physiologic lumbar lordosis has to be gained by intraoperative prone positioning with a hip extension and posterior instrumentation technique. There are some debates about changing lumbar lordosis on the OSI frame after an intraoperative prone position. We evaluated the effect of spondylolisthesis on lumbar lordosis after an intraoperative prone position.

Methods

Sixty-seven patients, who underwent spinal fusion at the Department of Orthopaedic Surgery of Gwangmyeong Sungae Hospital between May 2007 and February 2012, were included in this study. The study compared lumbar lordosis on preoperative upright, intraoperative prone and postoperative upright lateral X-rays between the simple stenosis (SS) group and spondylolisthesis group. The average age of patients was 67.86 years old. The average preoperative lordosis was 43.5° (± 14.9°), average intraoperative lordosis was 48.8° (± 13.2°), average postoperative lordosis was 46.5° (± 16.1°) and the average change on the frame was 5.3° (± 10.6°).

Results

Among all patients, 24 patients were diagnosed with simple spinal stenosis, 43 patients with spondylolisthesis (29 degenerative spondylolisthesis and 14 isthmic spondylolisthesis). Between the SS group and spondylolisthesis group, preoperative lordosis, intraoperative lordosis and postoperative lordosis were significantly larger in the spondylolisthesis group. The ratio of patients with increased lordosis on the OSI frame compared to preoperative lordosis was significantly higher in the spondylolisthesis group. The risk of increased lordosis on frame was significantly higher in the spondylolisthesis group (odds ratio, 3.325; 95% confidence interval, 1.101 to 10.039; p = 0.033).

Conclusions

Intraoperative lumbar lordosis on the OSI frame with a prone position was larger in the SS patients than the spondylolisthesis patients, which also produced a larger postoperative lordosis angle after posterior spinal fusion surgery. An increase in lumbar lordosis on the OSI frame should be considered during posterior spinal fusion surgery, especially in spondylolisthesis patients.     

Functional outcome of surgical treatment for multilevel lumbar spinal stenosis

BACKGROUND: There is no consensus regarding the best treatment of patients with multilevel lumbar stenosis. We evaluated the clinical and radiological findings in 41 patients with complex degenerative spinal stenosis of the lumbar spine who were treated surgically. METHODS: Between 1997 and 2003, 41 patients suffering from degenerative lumbar spinal stenosis were included in a prospective clinical study. The spinal stenosis was multilevel in all patients and in 13 of them there was degenerative scoliosis, in 18 there was degenerative spondylolisthesis, and in 10 there was segmental instability. Plain radiographs, MRI and/or CT myelograms were obtained preoperatively. The patients were assessed clinically with the Oswestry disability index (ODI) and visual analog scale (VAS). Surgery included wide posterior decompression and fusion using a trans-pedicular instrumentation system and bone graft. RESULTS: After a mean follow-up of 3.7 (1-6) years, the patients' clinical improvement on the ODI and VAS was statistically significant. Recurrent stenosis was not observed, and 39 of 41 patients were satisfied with the outcome. 3 patients with improvement initially had later surgery because of instability. INTERPRETATION: The above-mentioned technique gives good and long lasting clinical results, when selection of patients is done carefully and when the spinal levels that are to be decompressed are selected accurately.     

360°腰椎融合与后外侧融合治疗腰椎退行性疾病的疗效比较

[目的]分析360°腰椎融合与后外侧融合在治疗腰椎退行性疾病中的疗效.[方法]将2008年后在本科进行手术治疗的45例腰椎退行性疾病患者按融合方法不同分为360°腰椎融合组及后外侧融合组,回顾分析并比较两种融合方法在患者功能恢复、脊椎融合率、并发症的发生率及腰椎生理前凸保持方面的不同,评价两种融合方法的疗效差异.[结果]与术前相比,两组患者在生活质量及腰腿痛方面均有明显的改善,360°腰椎融合组患者改善更为明显.与后外侧融合组患者相比,360°腰椎融合组患者的腰椎生理前凸得到更好的保持,同时,腰椎融合率更高.[结论] 360°腰椎融合与后外侧融合相比,能更好的保持腰椎生理前凸,获得更高的融合率,减少并发症的发生,同时能使患者得到更好的功能恢复.     

Dynamische Versorgung der Lendenwirbels?ule

Total disc replacement and posterior dynamic stabilization represent alternatives to lumbar spinal fusion which should reduce the risk of adjacent segment degeneration. Disc replacement is indicated for pure discopathy without facet joint degeneration. Spinopelvic balance influences the implant's biomechanics. Therefore pelvic incidence, sacral slope, segmental lordosis and the mean axis of rotation need to be considered. Dynamic stabilization is indicated in moderate discopathy and facet joint degeneration, in degenerative spondylolisthesis grade I with a hypermobile segment and in dynamic lumbar stenosis. The combination of caudal fusion and cranial dynamic stabilization allows a better maintenance of lordosis with multiple level instrumentation and prevents adjacent segment degeneration. If pelvic incidence and sacral slope are high, L5-S1 should be fused because of elevated shear forces.     

Analysis of lumbar lordosis in posterior spine fusions for idiopathic scoliosis

Previous reports are inconclusive regarding changes in the lumbar region after Harrington rod distraction and posterior spinal fusion for idiopathic scoliosis. The purpose of this study was to evaluate the effects of spinal fusion on the lumbar region, particularly the overall lumbar lordosis, the lumbar lordosis in and below the fused segment, the sacro-horizontal angle, and the sagittal plane alignment of the spine. Sixty-six patients under 21 years of age with idiopathic scoliosis who had spine fusion extending to the lumbar vertebrae using only Harrington distraction instrumentation were evaluated. The total lordosis, sacro-horizontal angle, and sagittal plane alignment remained relatively constant. The lordosis within the fusion decreased, and lordosis caudal to the fusion, including the last fused vertebra, increased as the lower hook placement site moved caudally.     

Surgical treatment of symptomatic degenerative lumbar spondylolisthesis by decompression and instrumented fusion

Degenerative spondylolisthesis is characterized by the slippage of one vertebral body over the one below, with association of intervertebral disc degeneration and degenerative arthritis of the facet joints, which cause spinal stenosis. The aim of this study was to evaluate the clinical and radiographic results of 22 patients with symptomatic degenerative spondylolisthesis, operated on by decompressive laminectomy and instrumented posterolateral fusion associated with interbody fusion (PLIF). Mean age at surgery was 64 years (range, 57–72). Clinical results were evaluated on a questionnaire at the last follow-up visit concerning postoperative low back and leg pain, restriction of daily life activities, and resumption of sports activity. Lumbar spine radiographs were used to evaluate the status of fixation devices, the reduction of the spondylolisthesis, the lumbar sagittal balance and the presence of spinal fusion. No intraoperative or postoperative complications were encountered. There were no superficial or deep infections, fixation device loosening, or hardware removal. Mean follow-up time was 4 years (range, 3–6 years). Clinical outcome was excellent or good in 19 patients and fair in 3 patients. Preoperatively, mean forward vertebral slipping on neutral lateral radiographs was 5 mm, while postoperatively it decreased to 3 mm. Preoperatively, mean sagittal motion was 3 mm and angular motion was 8°, while postoperatively these values decreased to 1 mm and 1°, respectively. This study demonstrated that spinal decompression followed by transpedicular instrumentation associated with PLIF technique is a valid surgical option for the treatment of degenerative spondylolisthesis with symptomatic spinal stenosis. Clinical outcome, intended as relief of pain and resumption of activity, was improved significantly and fusion rate was high.