J Korean Soc Spine Surg.  2003 Jun;10(2):119-126. 10.4184/jkss.2003.10.2.119.

Surgical Treatment of Isthmic Spondylolisthesis: Pedicle Screw Fixation, Posterolateral Fusion, and Posterior Lumbar Interbody Fusion with Cage after Wide Decompression

• Na HY
• Jeong YY
• Kim WS
• Cho HW

• KMID: 2003209
• DOI: http://doi.org/10.4184/jkss.2003.10.2.119

Abstract

STUDY DESIGN: A retrospective study.
OBJECTIVES
To verify the advantages of adding gentle reduction and posterior lumbar interbody fusion (PLIF), using a cage to the usual posterolateral fusion (PLF), with pedicle screw instrumentation, in the surgical treatment of spinal stenosis with isthmic spondylolisthesis. SUMMARY OF LITERATURE REVIEW: The stabilization of isthmic spondylolisthesis, following decompression, is difficult. The PLIF, with a cage, offers anterior column support, reduction and a broad fusion base.
MATERIALS AND METHODS
31 patients were treated with wide decompression, pedicle screws fixation, PLF and PLIF, and followed up for more than 1 year. The degrees of slippage were grades I and II in 20 and 11 patients, respectively. The grade I patients were treated with gentle reduction of the slippage in the disc space, using a leverage maneuver with a Cobb's spinal elevator. The grade II patients were treated with the insertion of a pedicle screws, fixation of rods, reduction and distraction, and then insertion of a cage. After the procedure all the patients were evaluated for the reduction of spondylolisthesis, restoration of the disc space, radiological bony union and clinical results.
RESULTS
Ninety percent of the patients were rated as excellent or good. Fusion of the PLIF occurred in all patients. The average reduction in the spondylolisthesis was 42.6 and 47.8% in the grade I and II patients, respectively. The average restorations of the disc spaces were 46.9 and 100.2% in the grade I and II patients, respectively. The maintenance of the reduction and disc height were excellent in the final follow-up radiographs.
CONCLUSIONS
Adding gentle reduction and PLIF, using a cage, to the usual posterolateral fusion, with pedicle screw instrumentation, in the surgical treatment of spinal stenosis, with isthmic spondylolisthesis, showed satisfactory results in the reduction of the spondylolisthesis, the restoration of the disc height, the bony union and clinically.

Keyword

Isthmic spondylolisthesis; Reduction; Posterior lumbar interbody fusion; Posterolateral fusion

MeSH Terms

Decompression*
Elevators and Escalators
Follow-Up Studies
Humans
Retrospective Studies
Spinal Stenosis
Spondylolisthesis*

Figure

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  Fig. 1. Preoperative flexion-extension lateral radiographs of 59-year-old female shows grade II isthmic spondylolisthesis at L4-5 level.

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  Fig. 2. Magnetic resonance imaging in sagittal plane shows angulated and compressed dural sac and severely compressed nerve root at L4-5 intervertebral foramen.

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  Fig. 3. After wide decompression, reduction, PLIF with cage, pedicle screw instrumentation and PLF were done.

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  Fig. 4. Radiograph at 12 months follow-up examination shows reduction and restoration of disc height was well maintained with solid bony union.

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