J Korean Soc Spine Surg.  2002 Dec;9(4):313-321. 10.4184/jkss.2002.9.4.313.

Outcome of Two Fusion Methods In Isthmic and Degenerative Spondylolisthesis of the Lumbar Spine

• Lee KY
• Sohn SK
• Kim SW
• Lee SW

• KMID: 2209713
• DOI: http://doi.org/10.4184/jkss.2002.9.4.313

Abstract

DESIGN: A retrospective study was performed in isthmic and degenerative spondylolisthesis patients who had undergone posterolateral fusion (PLF) only (group I) or posterolateral fusion (PLF) with posterior lumbar interbody fusion (PLIF) (group II).
OBJECTIVES
The objective of this study was to help in the selection of a surgical treatment option for spondylolisthesis. SUMMARY OF LITERATURE REVIEW: Irrespective of whether group Ior group II, satisfactory results have been reported in the surgical treatment of spondylolisthesis. However, isthmic and degenerative types have not been investigated in terms of outcome.
MATERIALS AND METHODS
We analyzed 112 patients (Isthmic: group I(32), group II(22), Degenerative: group I(37), group II(21)) who underwent surgical treatment for spondylolisthesis between April 1995 and December 2000. Kirkaldy-Willis criteria, radiologic union state, reduction ratio of slippage, change of disc space and change of segmental angle were analyzed as indicators of outcome.
RESULTS
We found the following by radiologic analysis: In isthmic spondylolisthesis, group IIwas better than group Iin terms of reduction ratio of slippage (reduction loss:3.38% vs. 2.3%, P=0.15), change of segmental angle (reduction loss : 2.11 degrees vs. 1.6degrees, P=0.15), bone union (83% vs. 92%, P=0.45) and change of disc space (reduction loss : 2.83 mm vs. 1.9 mm, P=0.02). In the degen-erative spondylolisthesis, group IIdid not show significant difference from group Iin terms of reduced slippage (reduction loss: 3.8% vs. 3.85%, P=0.47), change of segmental angle (reduction loss: 2.73 degrees vs. 2.64 degrees, P=0.43), bone union (80% vs. 87%, P=0.72) or disc height (reduction loss: 3.2 mm vs. 3.14 mm, P=0.45). In terms of clinical outcome, group II was better than groups Iin cases of isthmic spondylolisthesis (fair < or =:85% vs. 93%, P=0.72), however, groups IIwas not better than groups Iin cases of degenerative spondylolisthesis (fair < or =:83% vs. 85%, P=0.23).
CONCLUSIONS
In the degenerative spondylolisthesis patient, no significant difference was found between group Iand group II, but in the isthmic spondylolisthesis patient, group I and group II were found to be significantly different in terms of the reduction ratio of the disc heights.

Keyword

Spondylolisthesis; Isthmic; Degenerative; PLF; PLIF

MeSH Terms

Humans
Retrospective Studies
Spine*
Spondylolisthesis*

Figure

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  Fig. 1. Isthmic Spondylolisthesis with PLF Fig. 1. A. Lateral radiograph of symptomatic isthmic spondylolisthesis in a 48-year-old female. Fig. 1.B. Postoperative radiograph demonstrated correction of deformity. Fig. 1. C. Last follow-up radiograph demonstrated loss of the correction.

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  Fig. 2. Isthmic Spondylolisthesis with PLF and PLIF Fig. 2. A. Lateral radiograph of symptomatic isthmic spondylolisthesis in a 53-year-old female. Fig. 2. B. Postoperative radiograph demonstrated full correction of deformity. Fig. 2. C. Last follow-up radiograph demonstrated well-consolidated interbody fusion without loss of the slippage.

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  Fig. 3. Degenerative Spondylolisthesis with PLF Fig. 3. A. Lateral radiograph of symptomatic degenerative spondylolisthesis L4 on L5 in a 52-year-old female. Fig. 3. B. Postoperative radiograph demonstrated correction of deformity. Fig. 3. C. Last follow-up radiograph demonstrated loss of disc height.

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  Fig. 4. Degenerative Spondylolisthesis with PLF and PLIF Fig. 4. A. Lateral radiograph of symptomatic degenerative spondylolisthesis in a 66-year-old female. Fig. 4. B. Postoperative radiograph demonstrated correction of deformity. Fig. 4. C. Last follow-up radiograph demonstrated loss of the correction and disc height.

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