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Early results of stand-alone anterior lumbar interbody fusion in iatrogenic spondylolisthesis patients

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Abstract

Background

Iatrogenic spondylolisthesis is a challenging condition for spinal surgeons. Posterior surgery in these cases is complicated by poor anatomical landmarks, scar tissue adhesion of muscle and dural structures and difficult access to the intervertebral disc. Anterior interbody fusion provides an alternative treatment method, allowing indirect foraminal decompression, reliable disc clearance and implantation of large surface area implants.

Materials and methods

A retrospective chart review of patients with iatrogenic spondylolisthesis including pre- and post-operative Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS) scores was performed. Imaging criteria were pelvic incidence, overall lumbar lordosis and segmental lordosis. In addition, the fusion rate was investigated after 6 months.

Results

Six consecutive patients treated between 2008 and 2011 (4 female, 2 male, mean age 61 ± 7.1 years) were identified. The initially performed surgeries included decompression with or without discectomy; posterior instrumented and non-instrumented fusion. The olisthetic level was in all cases at the decompressed level. All patients were revised with stand-alone anterior interbody fusion devices at the olisthetic level filled with BMP 2. Average ODI dropped from 49 ± 11 % pre-operatively to 26.0 ± 4.0 at 24 months follow-up. VAS average dropped from 7 ± 1 to 2 ± 0. Mean total lordosis of 39.8 ± 2.8° increased to 48.5 ± 4.9° at pelvic incidences of 48.8 ± 6.8° pre-operatively. Mean segmental lordosis at L4/5 improved from 10.5 ± 6.7° to 19.0 ± 4.9° at 24 months. Mean segmental lordosis in L5/S1 increased from 15.1 ± 7.4° to 23.2 ± 5.6°. Cage subsidence due to severe osteoporosis occurred in one case after 5 months, and hence there was no further follow-up. Fusion was confirmed in all other patients.

Conclusion

Anterior interbody fusion offers good stabilisation and restoration of lordosis in iatrogenic spondylolisthesis and avoids the well-known problems associated with reentering the spinal canal for revision fusions. In this group, ODI and VAS scores were improved.

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References

  1. Johnsson KE, Willner S, Johnsson K (1986) Postoperative instability after decompression for lumbar spinal stenosis. Spine 11(2):107–110

    Article  PubMed  CAS  Google Scholar 

  2. Lee CK (1983) Lumbar spinal instability (olisthesis) after extensive posterior spinal decompression. Spine 8(4):429–433

    Article  PubMed  CAS  Google Scholar 

  3. Suzuki K, Ishida Y, Ohmori K (1993) Spondylolysis after posterior decompression of the lumbar spine. 35 patients followed for 3-9 years. Acta Orthop Scand 64(1):17–21

    Article  PubMed  CAS  Google Scholar 

  4. Brunet JA, Wiley JJ (1984) Acquired spondylolysis after spinal fusion. J Bone Jt Surg Br 66(5):720–724

    CAS  Google Scholar 

  5. Harris RI, Wiley JJ (1963) Acquired spondylolysis as a sequel to spine fusion. J Bone Jt Surg Am 45:1159–1170

    CAS  Google Scholar 

  6. Rombold C (1965) Spondylolysis: a complication of spine fusion. J Bone Jt Surg Am 47:1237–1242

    CAS  Google Scholar 

  7. Blasier RD, Monson RC (1987) Acquired spondylolysis after posterolateral spinal fusion. J Pediatr Orthop 7(2):215–217

    Article  PubMed  CAS  Google Scholar 

  8. Frymoyer JW, Matteri RE, Hanley EN, Kuhlmann D, Howe J (1978) Failed lumbar disc surgery requiring second operation.A long-term follow-up study. Spine 3(1):7–11

    Article  PubMed  CAS  Google Scholar 

  9. Maurer SG, Wright KE, Bendo JA (2000) Iatrogenic spondylolysis leading to contralateral pedicular stress fracture and unstable spondylolisthesis: a case report. Spine 25(7):895–898

    Article  PubMed  CAS  Google Scholar 

  10. Celik SE, Celik S, Göksu K, Kara A, Ince I (2010) Microdecompressive laminatomy with a 5-year follow-up period for severe lumbar spinal stenosis. J Spinal Disord Tech. 23(4):229–235

    Article  PubMed  Google Scholar 

  11. Hong SW, Choi KY, Ahn Y, Baek OK, Wang JC, Lee SH, Lee HY (2011) A comparison of unilateral and bilateral laminotomies for decompression of L4-L5 spinal stenosis. Spine 36(3):E172–E178

    Article  PubMed  Google Scholar 

  12. Kwon BK, Albert TJ (2005) Adult low-grade acquired spondylolytic spondylolisthesis: evaluation and management. Spine 30(6 Suppl):S35–S41

    Article  PubMed  Google Scholar 

  13. Deguchi M, Rapoff AJ, Zdeblick TA (1999) Biomechanical comparison of spondylolysis fixation techniques. Spine 24(4):328–333

    Article  PubMed  CAS  Google Scholar 

  14. Zdeblick TA (1999) Discogenic back pain. In: Herkowitz HN, Garfin SR, Balderston RA et al (eds) The Spine, 4th ed. Saunders, Philadelphia, pp 748–765

  15. L’Heureux EA Jr, Perra JH, Pinto MR, Smith MD, Denis F, Lonstein JE (2003) Functional outcome analysis including preoperative and postoperative SF-36 for surgically treated adult isthmic spondylolisthesis. Spine 28(12):1269–1274

    PubMed  Google Scholar 

  16. Jarrett CD, Heller JG, Tsai L (2009) Anterior exposure of the lumbar spine with and without an “access surgeon”: morbidity analysis of 265 consecutive cases. J Spinal Disord Tech 22(8):559–564

    Article  PubMed  Google Scholar 

  17. Kulkarni SS, Lowery GL, Ross RE, Ravi Sankar K, Lykomitros V (2003) Arterial complications following anterior lumbar interbody fusion: report of eight cases. Eur Spine J 12(1):48–54

    PubMed  Google Scholar 

  18. König MA, Leung Y, Jürgens S, MacSweeney S, Boszczyk BM (2011) The routine intra-operative use of pulse oximetry for monitoring can prevent severe thromboembolic complications in anterior surgery. Eur Spine J 20(12):2097–2102

    Article  PubMed  Google Scholar 

  19. Barrick WT, Schofferman JA, Reynolds JB, Goldthwaite ND, McKeehen M, Keaney D, White AH (2000) Anterior lumbar fusion improves discogenic pain at levels of prior posterolateral fusion. Spine 25(7):853–857

    Article  PubMed  CAS  Google Scholar 

  20. Ishihara H, Osada R, Kanamori M, Kawaguchi Y, Ohmori K, Kimura T, Matsui H, Tsuji H (2001) Minimum 10-year follow-up study of anterior lumbar interbody fusion for isthmic spondylolisthesis. J Spinal Disord 14(2):91–99

    Article  PubMed  CAS  Google Scholar 

  21. Meyerding HW (1932) Spondylolisthesis. Surg Gynaecol Obstet 54:371–377

    Google Scholar 

  22. Bisschop A, van Royen BJ, Mullender MG, Paul CP, Kingma I, Jiya TU, van der Veen AJ, van Dieën JH (2012) Which factors prognosticate spinal instability following lumbar laminectomy? Eur Spine J [Epub ahead of print]

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Conflict of interest

No benefits or funds in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

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Authors and Affiliations

  1. The Centre for Spinal Studies and Surgery, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, NG7 2UH, UK

    M. A. König, F. V. Ebrahimi, A. Nitulescu, E. Behrbalk & B. M. Boszczyk

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  1. M. A. König
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  2. F. V. Ebrahimi
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  3. A. Nitulescu
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  4. E. Behrbalk
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  5. B. M. Boszczyk
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Correspondence to M. A. König.

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König, M.A., Ebrahimi, F.V., Nitulescu, A. et al. Early results of stand-alone anterior lumbar interbody fusion in iatrogenic spondylolisthesis patients. Eur Spine J 22, 2876–2883 (2013). https://doi.org/10.1007/s00586-013-2970-7

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  • DOI: https://doi.org/10.1007/s00586-013-2970-7

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