SURGICAL TREATMENT IN LUMBAR SPONDYLOLISTHESIS: EXPERIENCE WITH 45 PATIENTS

Authors

  • 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, whichat times requires surgery. The objective of present study is to document the outcome of surgicaltreatment in spondylolisthesis of lumbosacral region. Methods: We reviewed outcome of surgery in 45patients with spondylolisthesis. Improvement in pain intensity, neurological status and union achievedafter surgery was studied. All patients requiring surgical treatment were included in the study. Thepatients were operated by single spine surgeon. A Performa was made for each patient and recordswere kept in a custom built Microsoft access database. Results: Majority of our patient were in 4th and5th decade with some male domination. Pain was main indication for surgery which was excruciating in6, severe in 33, and moderate in 6 cases. The neurological status was normal in 34 cases while 11patients had some deficit. L5–S1 was affected in 26, L4–L5 in 13 and multi or high level was found inrest of cases. Slip grade was measured with Meyerding grades, 18 had grade II, 15 had I, 9 had III and 3had 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. Translaminarscrew fixation, transpedicular transdiscal transcorporial and Delta fixation in some cases. Pedicle screwfixation was done in most cases, AO fixator internae and 4.5 mm screw in others. Average follow upwas 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 neurologicalstatus, two implant failure and one wound infection. Conclusion: Surgical procedure forSpondylolisthesis must be individualised. Young patients with spondylolysis can be treated withosteosynthesis and sparing of motion segment. PLIF provides satisfactory results in majority of low tomoderate cases with some reduction. Transpedicular transdiscal transcorprial and delta fixation is goodprocedure for severe slips in adult.Keywords: Spondylolisthesis, Spondylolysis, Pedicle screw fixation, Posterior lumbar inter body fusion

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Published

2012-03-01