Journal of Orthopaedics and Traumatology

, Volume 8, Issue 3, pp 128–133

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

  • C. Faldini
  • S. Pagkrati
  • F. Acri
  • M. T. Miscione
  • D. Francesconi
  • S. Giannini
Original

Abstract

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.

Key words

Degenerative spondylolisthesis Interbody fusion Pedicle instrumentation Spinal fusion 

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References

  1. 1.
    Marchetti PG, Bartolozzi P (1997) Classification of spondylolisthesis as a guideline for treatment. In: Bridwell KH and Dewald RL (Eds), The textbook of spinal surgery, 2nd edn. Lippincott-Raven, Philadelphia, pp 1211–1254Google Scholar
  2. 2.
    Fitzgerald JAW, Newman PH (1976) Degenerative spondylolisthesis. J Bone Joint Surg Br 58:184–192PubMedGoogle Scholar
  3. 3.
    Mardjetko SM, Connolly PJ, Shott S (1994) Degenerative lumbar spondylolisthesis: a meta-analysis of literature 1970–1993. Spine 19:2256S–2265SPubMedCrossRefGoogle Scholar
  4. 4.
    Kornblum MB, Fischgrund JS, Herkowitz HN et al (2004) Degenerative lumbar spondylolisthesis with spinal stenosis: a prospective long-term study comparing fusion and pseudoarthrosis. Spine 29:726–734PubMedCrossRefGoogle Scholar
  5. 5.
    Weinstein JN, Lurie JD, Tosteson TD et al (2007) Surgical versus nonsurgical treatment for lumbar degenerative spondylolisthesis. N Engl J Med 356:2257–2270PubMedPubMedCentralCrossRefGoogle Scholar
  6. 6.
    Hammerberg KW (2005) New concepts on the pathogenesis and classification of spondylolisthesis. Spine 30:S4–S11PubMedCrossRefGoogle Scholar
  7. 7.
    Vibert BT, Sliva CD, Herkowitz HN (2006) Treatment of instability and spondylolisthesis. Clin Orthop Relat Res 443:222–227PubMedCrossRefGoogle Scholar
  8. 8.
    Sengupta DK, Herkowitz HN (2005) Degenerative spondylolisthesis: review of current trends and controversies. Spine 30:S71–S81PubMedCrossRefGoogle Scholar
  9. 9.
    Grobler LJ, Robertson PA, Novotny JE et al (1993) Etiology of spondylolisthesis: assessment of the role played by lumbar facet joint morphology. Spine 18:80–91PubMedCrossRefGoogle Scholar
  10. 10.
    Barrey C, Jund J, Noseda O et al (2007) Sagittal balance of the pelvis-spine complex and lumbar degenerative diseases. A comparative study about 85 cases. Eur Spine J: Jan 9; [Epub ahead of print]Google Scholar
  11. 11.
    Vialle R, Ilharreborde B, Dauzac C et al (2007) Is there a sagittal imbalance of the spine in isthmic spondylolisthesis? A correlation study. Eur Spine J: Apr 17, [Epub ahead of print]Google Scholar
  12. 12.
    Boulay C, Tardieu C, Hercquet J et al (2006) Sagittal alignement of spine and pelvis regulated by pelvic incidence: standard values and prediction of lordosis. Eur Spine J 15:415–422PubMedPubMedCentralCrossRefGoogle Scholar
  13. 13.
    Rosenberg NJ (1975) Degenerative spondylolisthesis: predisposing factors. J Bone Joint Surg Am 57:467–474PubMedGoogle Scholar
  14. 14.
    Fischgrund JS, Mackay M, Herkowitz HN et al (1997) Degenerative lumbar spondylolisthesis with spinal stenosis: a prospective, randomized study comparing decompressive laminectomy and spinal instrumentation. Spine 22:2807–2812PubMedCrossRefGoogle Scholar
  15. 15.
    Gibson JNA, Waddell G (2005) Surgery for degenerative lumbar spondylosis: updated Cochrane review. Spine 30:2312–2320PubMedCrossRefGoogle Scholar
  16. 16.
    McAfee PC, DeVine JG, Chaput CD et al (2005) The indications for interbody fusion cages in the treatment of spondylolisthesis: analysis of 120 cases. Spine 30:S60–S65PubMedCrossRefGoogle Scholar
  17. 17.
    Fernàndendez-Fairen M, Sala P, Ramìrez H (2007) A prospective randomized study of unilateral versus bilateral instrumented posterolateral lumbar fusion in degenerative spondylolisthesis. Spine 32:395–401CrossRefGoogle Scholar
  18. 18.
    Rousseau MA, Lazennec JY, Bass ES et al (2005) Predictors of outcomes after posterior decompression and fusion in degenerative spondylolisthesis. Eur Spine J 14:55–60PubMedPubMedCentralCrossRefGoogle Scholar
  19. 19.
    Bridwell KH, Sedgewick TA, O’Brien MF et al (1993) The role of fusion and instrumentation in the treatment of degenerative spondylolisthesis with spinal stenosis. J Spinal Disord 6:461–472PubMedCrossRefGoogle Scholar
  20. 20.
    Enken P, Steffee AD (1994) Interbody fusion and instrumentation. Clin Orthop Relat Res 300:90–101Google Scholar
  21. 21.
    Glaser JA, Bernhardt M, Found EM et al (2004) Lumbar arthrodesis for degenerative conditions. AAOS Instruct Course Lect 53:325–340Google Scholar
  22. 22.
    La Rosa G, Conti A, Cacciola F et al (2003) Pedicle screw fixation for isthmic spondylolisthesis: does posterior lumbar interbody fusion improve outcome over posterolateral fusion? J Neurosurg 99:143–150PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2007

Authors and Affiliations

  • C. Faldini
    • 1
  • S. Pagkrati
    • 1
  • F. Acri
    • 1
  • M. T. Miscione
    • 1
  • D. Francesconi
    • 1
  • S. Giannini
    • 1
  1. 1.Department of Orthopaedic SurgeryUniversity of Bologna Rizzoli Orthopaedics InstituteBolognaItaly

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