SURGICAL TREATMENT IN LUMBAR SPONDYLOLISTHESIS: EXPERIENCE WITH 45 PATIENTS

Ibrahim Farooq Pasha, Muhammed Abid Qureshi, Irfan Zafar Haider, Arsalan Sharif Malik, Muhammad Asad Qureshi, Usama Bin Tahir

Abstract


Background: Spondylolithesis is forward slipping of upper vertebra in relation to its lower one, which
at times requires surgery. The objective of present study is to document the outcome of surgical
treatment in spondylolisthesis of lumbosacral region. Methods: We reviewed outcome of surgery in 45
patients with spondylolisthesis. Improvement in pain intensity, neurological status and union achieved
after surgery was studied. All patients requiring surgical treatment were included in the study. The
patients were operated by single spine surgeon. A Performa was made for each patient and records
were kept in a custom built Microsoft access database. Results: Majority of our patient were in 4th and
5th decade with some male domination. Pain was main indication for surgery which was excruciating in
6, severe in 33, and moderate in 6 cases. The neurological status was normal in 34 cases while 11
patients had some deficit. L5–S1 was affected in 26, L4–L5 in 13 and multi or high level was found in
rest of cases. Slip grade was measured with Meyerding grades, 18 had grade II, 15 had I, 9 had III and 3
had IV spondylolisthesis. Posterior lumbar inter body fusion (PLIF) was done in 24 patients,
posterolateral, transforaminal lumbar inter body and anterior inter body fusion in others. Translaminar
screw fixation, transpedicular transdiscal transcorporial and Delta fixation in some cases. Pedicle screw
fixation was done in most cases, AO fixator internae and 4.5 mm screw in others. Average follow up
was 2 years and 5 months, max 5 years and minimum 6 months. Pain relief was achieved in 82%,
neurological improvement 60% and union in 91% cases. There was no deterioration of neurological
status, two implant failure and one wound infection. Conclusion: Surgical procedure for
Spondylolisthesis must be individualised. Young patients with spondylolysis can be treated with
osteosynthesis and sparing of motion segment. PLIF provides satisfactory results in majority of low to
moderate cases with some reduction. Transpedicular transdiscal transcorprial and delta fixation is good
procedure for severe slips in adult.
Keywords: Spondylolisthesis, Spondylolysis, Pedicle screw fixation, Posterior lumbar inter body fusion

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