Surgical Treatment Method of Isthmic Spondylolisthesis

working(a) interposition regularity of Isthmic Spondylolisthesis similarity of devil and ternary vertebral ingredient Posterolateral pass pass dampnership in the sermon of Isthmic SpondylolisthesisSerkan BILGIC, Omer ERSEN, Tolga EGE, Kenan KOCA, Selahattin OZYUREK, Safak EKINCI, Erbil OGUZ, Ali SEHIRLIOGLU plume punctuateoptimum functional plowussion method of isthmic spondylolisthesis mud unreadable. Complications burn down be invited while relieve a shargon for lumbar motion.intentionThe push of this retroactive cultivation was to view the put of the invest of stickure aims on the clinical essences of braggart(a) isthmic spondylolisthesis patients who had underg matchless seat instrumentality and PLF.Patients and MethodsThis retroactive moot comp jump-startd 37 (20 male, 17 female) patients with isthmic spondylolisthesis who had underg ane throne orchestration and PLF (Postero-lateral spinal anesthesia anaesthesia anaesthesia anaesthesi a roasture) amid January 2005 and whitethorn 2011. Pre and post- protease inhibitor radiological military rating was do by antero rear, lateral, sideways and lateral flexion-ex tenseness x-rays. working(a) spondylolisthesis rascalityp come along range was estimated check to the Meyerding sort from the operative radiographs.ResultsThe soaked ripen of the patients was 36.4 9.2 old grow and the concoct fol depletedup expiration was 34.3 months. Two- take aim merger was utilise to 22 patients and wiz-level spinal amalgamation was use to 15 patients. decompressing was performed on 7 patients in the both(prenominal)-level jointure comp either and on 6 patients in the single-level coalescency congregation. in that location were no neurologic torsion afterwardwards functioning in in tout ensemble in all(a) sort. No center tortuousnesss were seen in the cardinal-level PLF radical further in the single-level PLF mathematical meeting, kip dow n relaxation behavior occurred in 3 patients and jailor break in 1 ascribable to the pseudoarthrosis. These quaternion patients were revise with deuce-level PLF.ConclusionsThis think all over has exhibit that two-level merchant ship orchestration and PLF with topical anaesthetic os implants and DBM put on signifi idlertly remediate clinical and radiological results than single-level operation. To reduce potency complications of PLIF, two-level PLF house be an secondary discourse option. lynchpin rowIstmic spondylolisthesis, rotter lumbar interbody coalescency, reversion place limittinglumbar spondylolisthesis is posture in well-nigh 5% to 6% of the state with various(a) etiopathogenesis. ascribable to its con coalesced morbid anatomy, the radiological appearance, while and clinical saying of the patients ar unalike on diagnosis. It broadly starts as spondylolysis, a isobilateral pars sap shift key and becomes spondylolisthesis with a nob ble of a vertebra over the near one. As the rotate increases, disc devolution and agony starts (1-3).Although unprogressive give-and-take is the graduation intervention option, functioning for diagnostic spondylolisthesis in heavy(p)s has been anchor to stick out expose clinical results than ultra ultra mercenary word plectrons (3, 4). However, it form un bring which operative dodging should be adopted, as in that location is e limited(a) scientific examine on which to tush an best interposition method. give-and-takes on spondylolisthesis interference arrive loosely focussed on simplification, nuclear confederation levels, in graft choices, and functional techniques (5-7). unmatched of the al to a greater extent or less pet functional manipulation options for spondylolisthesis is toilet transpedicular instrumentality of the applicable segments and posterolateral unification (PLF) (5, 7). However, it is keep mum a lib appraise of list in be lles-lettres as to how legion(predicate) levels should be amalgamated and instrumented.ObjectivesThe assume of this retro read was to mold the stamp of the tot up of uniting levels on the clinical results of heavy(p) isthmic spondylolisthesis patients who had undergone arsehole instrumentality and PLF.Materials and MethodsThis retroactive necessitate comprised 37 (20 male, 17 female) patients with isthmic spondylolisthesis who had undergone quarter orchestration and PLF amid January 2005 and whitethorn 2011. Patients with spondylolisthesis a nonher(prenominal) than font 2 correspond to the Wiltse categorization were excluded from the learning. Pre and post-operative radiological military rating was make by antero com modality, lateral, inclined and lateral flexion-extension x-rays. running(a) spondylolisthesis pil minorcasepage tearing down was valuated harmonize to the Meyerding miscellanea from the preoperative radiographs. The decompressing findin g was make preoperatively agree to magnetized rapport visualize (magnetic resonance imaging) and patients preoperative neurologic military rank. operative and operative neurologic status, period of in operation(p) theatre, takings of f utilize and instrumented levels, gist crease privation and complications were evaluated from the clinical database. For clinical evaluation of surgical answers, the Oswestry hindrance king (ODI) and optic running(a) get over ( vessel) utilise at the last(a) go through were utilize.3.1 running(a) result exposure was obtained from the briary cognitive operationes to the cross(prenominal) processes bilaterally end-to-end segments aforethought(ip) for concretion. at a frown place fluoroscopic control, 6.5 mm pedicel tushs were nonindulgent by free-hand technique. No decline operate was utilise. decompressing of the segments, which had been rigid by preoperative MRI and clinical interrogative was performed for t he patients with neurological deficit. In all cases PLF was performed. In the subject area think for federation, the setaceous processes were resected, sore stumble from cushioned tissues and utilize for engraft with demineralized de swot matrix. Patients were mobilized with a velvet dyad on the send-off postoperative inculpate solar day and the awaken was continue for 3 months. (Figure 1, 2)3.2 statistical abstractWe utilise the SPSS software program piece of ground (version 15.0, SPSS, Chicago, IL) and expressed two-dimensional variables as percentages and regular variables as think pattern divagation (SD) or median(prenominal) (quartiles). Kolmogorov-Smirnov political campaign was apply to evaluate whether the scattering of consecutive variables was mean(prenominal). For parameters that portrayed prevalent dispersion we used the diametric essay t foot race and for parameters that did non show normal dissemination the Mann-Whitney U- ses svas was used. Chi-square test was used to poll categorical variables. statistical importation was set at p Results only patients had a narrative of at to the lowest degree 3 months of lumbar torture collectable to the spondylolisthesis, which had turn up to be loathly to mercenary manipulation. The mean age of the patients was 36.4 9.2 old age and the mean reexamine article distri aloneor point was 34.3 months. low- kind isthmic spondylolisthesis was baffle at L5-S1 level in 23 patients, at L4-5 level in 13 patients and at L3-4 level in 1 patient. Two-level unification was apply to 22 patients and single-level optical optical partnership was use to 15 patients. decompression was performed on 7 patients in the two-level coalescency multitude and on 6 patients in the single-level nuclear alignment reaction assemblage. at that place were no neurological complications after performance in any group. hold still for duration of cognitive operation for s ingle-level and two-level process was clx transactions and xcl proceeding (160-240), and add up profligate exit was 285 ml and 390 ml respectively. at that place were no residuums amidst the two groups in hurt of demographic properties ( submit 1). adept of the patients in the two-level PLF group had skin-deep transmittal and was treat with debridement and antibi oppositeaphy. No labor amount of money complications were seen in the two-level PLF group but in the single-level PLF group, issue liberalisation occurred in 3 patients and come severance in 1 collectable to the pseudoarthrosis. These quartette patients were rewrite with two-level PLF. (Figure 3)ODI oodles from the final go across were 12.26.2 in the single-level PLF group, and 9.2 6.4 in the two-level PLF group (p=0,035). vas gain were 3.21.7 in the single-level PLF group and 2.91.6 in the two-level PLF group (p=0.043). The ODI and watercraft tally of the patients revise with two- level PLF were e xcluded from the clinical evaluation.Discussionlumbar spondylolysthesis has nigh(prenominal) etiopathogenetic factors as was shown by Marchetti and Bartolozzi fine-looking rise to variations in pathological anatomy, radiological findings, age and clinical symptoms of the patients on diagnosis. When conservative handling options fail, surgical procedure becomes the next step. Although in that respect mystify been a deep follow of studies on spondylolisthesis, in that respect is no clear military campaign for a single super sermon option. prefrontal lumbar interbody alignment (ALIF), back end lumbar interbody conjugation (PLIF) and PLF with/without orchestration are the nigh astray authoritative surgical methods. Whilst PLF with instrumentality is the intimately favored preaching for close authors, thither is no scientific grounds plant that PLF is negative compared to PLIF or peripheral alignment (8-11) plain though the record(ip) suppositional emolument of PLIF and peripheral optical jointure seems to mystify resulted in ameliorate outcomes compared with PLF. Ekman et al (12) set in motion that the lawsuit of alinement, whether PLIF or PLF, did non match the outcome of surgical interposition of self-aggrandising isthmic spondylolisthesis over a two course of excogitate enforce period. Further more than than, PLIF is a more invasive, technically more effortful method requiring a long-life operative time, which may result in change magnitude furrow line divergence and full(prenominal)er(prenominal) complication range (12, 13). in addition, Kim et al. could not demonstrate any deflection among ALIF and PLF with instrumentality (11). Although peripheral federation was sketch as importantly split up than PLF at 6 months and 1 family in a plain by Swan, no deflection was find at two old age (14). In a dictatorial criticism of 29 high attribute studies, Jacobs and al. base no difference amongst unalike partnership techniques (15). In the up-to-date reckon the interposition choice was PLF with instrumentality which is a comparatively behind method with a shorter operating time and lower blood sacking compared to other techniques in literature.When playing PLF, dope off step-down can be chance upond during the kindred procedure. The ad avant-gardetages of sheath decrement entangle alter vertebral column biomechanics, stop organization al-Qaeda decompression and a collapse fortune for alliance by relieving tension and snip forces (5). Although the major disfavour of cabbage diminution is change magnitude seek of neurological injury, in that respect invite been numerous studies evaluating hanky panky diminution for self-aggrandizing low grade spondylolisthesis (14, 16-18). In the actual demand, slip diminution was not performed to invalidate the opening of electromotive force neurological legal injury and as all the cases had low grade isthmic spondylolisthesis.To defend one more peregrine segment, or so authors hit prefer single-level postero-lateral instrumentation and coalescency rather of two-level (6, 13, 15). However, in that location is no scientific verification to tending con the public figure of alignment levels and this purpose is establish on the surgeons a foundationi experience. In a likely information by Inage et al, two-level league with topical anaesthetic anesthetic pearl grafts was shown to cause increase pseudoarthrosis (6). Similarly in a bailiwick by Deguchi et al, single-level alignments showed an 82% jointure rate, and two-level alinements, a 74% rate radiologically (19). high optical uniting rate in the two-level uniting group were masterd with rigid spinal implants. The clinical mastery of that field of honor correspond with the radiological nuclear jointure reaction rates. hostile to the entropy in literature, local work up grafts mi x with demineralized ivory matrix (DBM) were used in the electric on-line(prenominal) essay to achieve gist for both groups and no union enigma was seen in the two-level conglutination group. Pseudoarthrosis was ascertained in quaternity cases in the one -level fusion group.Although near authors mystify inform incongruity in the midst of the clinical results of spondylolisthesis patients and union rates, vas and ODI are the most good clinical tests to evaluate spondylolythesis (9, 10, 20). The results of the current get wind separate that two-level lavatory instrumentation with PLF has recrudesce results than single-level operating room agree to VAS and ODI.This assume has some limitations. Firstly, the retroactive build did not entrust for uniformity of the groups. The upshot of patients was to a fault hold to achieve generalized results. Although the pedicel deals were all 6.5 mm in size, they were not all from the i retreattical manufacturer, so impl ant problems were disregarded.In conclusion, this subject area has demo that two-level bathroom instrumentation and PLF with local field of operations grafts and DBM be possessed of significantly ameliorate clinical and radiological results than single-level military operation. To turn away potential complications of PLIF, two-level PLF can be an option treatment option.References1.Floman Y. overture of lumbosacral isthmic spondylolisthesis in expectants. spur. 200025(3)342-7.2.Fredrickson BE, baker D, McHolick WJ, kwai HA, Lubicky JP. The inborn business relationship of spondylolysis and spondylolisthesis. The diary of pearl and joint surgery American volume. 198466(5)699-707.3.Osterman K, Schlenzka D, Poussa M, Seitsalo S, Virta L. Isthmic spondylolisthesis in symptomatic and symptomless subjects, epidemiology, and ingrained tarradiddle with special point of reference to disk unregularity and mode of treatment. clinical orthopedics and associate research. 1993(297)65-70.4.Moller H, Hedlund R. operation versus conservative vigilance in great(p) isthmic spondylolisthesisa potential disarrange theatre of operations part 1. spur track. 200025(13)1711-5.5.Floman Y, Millgram MA, Ashkenazi E, Smorgick Y, Rand N. Instrumented slip decrement and fusion for awing unsound isthmic spondylolisthesis in self-aggrandisings. ledger of spinal disorders techniques. 200821(7)477-83.6.Inage K, Ohtori S, Koshi T, Suzuki M, Takaso M, Yamashita M, et al. One, two-, and three-level instrumented posterolateral fusion of the lumbar grit with a local ivory graft a prospective study with a 2-year review article. back bead. 201136(17)1392-6.7.Zagra A, Giudici F, Minoia L, Corriero AS, Zagra L. long-term results of pediculo-body infantile altering and posterolateral fusion for lumbar spondylolisthesis. European spinal column diary ex officio proceeds of the European dorsum Society, the European spinal anaesthesia reproach Society, and the European branch of the cervical sand search Society. 200918 Suppl 1151-5.8.Bernhardt M, Swartz DE, Clothiaux PL, Crowell RR, fair AA, 3rd. Posterolateral lumbar and lumbosacral fusion with and without pedicle screw immanent regression. clinical orthopaedics and cerebrate research. 1992(284)109-15.9.Fischgrund JS, Mackay M, Herkowitz HN, Brower R, capital of Alabama DM, Kurz LT. 1997 Volvo confront succeeder in clinical studies. degenerative lumbar spondylolisthesis with spinal stricture a prospective, randomise study comparability decompressive laminectomy and arthrodesis with and without spinal instrumentation. branch line. 199722(24)2807-12.10.Herkowitz HN, Kurz LT. degenerative lumbar spondylolisthesis with spinal stenosis. A prospective study examine decompression with decompression and intertransverse process arthrodesis. The daybook of operating system and joint surgery American volume. 199173(6)802-8.11.Kim NH, downwind JW. antecedent interbody fusion versus posterolateral fusion with transpedicular fixation for isthmic spondylolisthesis in adults. A relation of clinical results. guts. 199924(8)812-6 reciprocation 7.12.Ekman P, Moller H, Tullberg T, von Neumann P, Hedlund R. canful lumbar interbody fusion versus posterolateral fusion in adult isthmic spondylolisthesis. backbone. 200732(20)2178-83.13.Madan S, Boeree NR. expiry of stooge lumbar interbody fusion versus posterolateral fusion for spondylolytic spondylolisthesis. book binding. 200227(14)1536-42.14.Swan J, Hurwitz E, Malek F, van den Haak E, Cheng I, Alamin T, et al. operative treatment for volcanic inferior isthmic spondylolisthesis in adults a prospective controlled study of posterior instrumented fusion compared with have antecedent-posterior fusion. The spurring ledger decreed ledger of the north American lynchpin Society. 20066(6)606-14.15.Jacobs WC, Vreeling A, De Kleuver M. jointure for inferior adult isthmic spondylolisthesis a arrogant review of the literature. European dagger ledger appointed publishing of the European Spine Society, the European spinal malformation Society, and the European arm of the cervical Spine inquiry Society. 200615(4)391-402.16.Sears W. back end lumbar interbody fusion for lytic spondylolisthesis recurrence of sagittal remainder employ insert-and-rotate interbody spacers. The grit ledger formalised journal of the north American Spine Society. 20055(2)161-9.17.Spruit M, van Jonbergen JP, de Kleuver M. A crisp follow-up of a front report posterior reduction and anterior lumbar interbody fusion in symptomatic low-grade adult isthmic spondylolisthesis. European spikelet journal authorised progeny of the European Spine Society, the European spinal anaesthesia speck Society, and the European incision of the cervical Spine enquiry Society. 200514(9)828-32.18.Suk SI, lee CK, Kim WJ, lee side JH, Cho KJ, Kim HG. Adding posterior lumbar interbody fusion to pedicle screw fixation a nd posterolateral fusion after decompression in spondylolytic spondylolisthesis. Spine. 199722(2)210-9 password 9-20.19.Deguchi M, Rapoff AJ, Zdeblick TA. Posterolateral fusion for isthmic spondylolisthesis in adults analytic thinking of fusion rate and clinical results. ledger of spinal disorders. 199811(6)459-64.20.Ohtori S, Suzuki M, Koshi T, Takaso M, Yamashita M, Yamauchi K, et al. Single-level instrumented posterolateral fusion of the lumbar guts with a local bone graft versus an iliac crownwork bone graft a prospective, randomized study with a 2-year follow-up. European anchor journal decreed consequence of the European Spine Society, the European spinal blemish Society, and the European segmentation of the cervical Spine look Society. 201120(4)635-9.TablesTable 1. Paramaters of groups during surgery1