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 17,525 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The basic principles of the operative treatment of lumbar spondylolisthesis became uniform in the literature in the last years. Authors deal shortly with some questions of the indication and of the preoperative examination and describe shortly the basic principles of the operative treatment (decompression, reduction, stabilization). The operative methods used by them are reported and illustrated (Morscher's "hookscrew" method, fusion according to Harrington-Vidal, Cloward's posterior corpodesis--PLIF--and Steffee's transpedicular system).
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PMID:[Surgical management of lumbar spondylolisthesis]. 257 Aug 89

Over the past seven years, 96 PLIF operations were performed with the autologous bone graft method. In 44 cases, unicortical bone grafts were obtained from the posterior iliac crest area. In the remaining 52 cases, bicortical bone grafts were obtained from the anterior iliac crest. The failure rate in the patients treated by interbody fusion with the unicortical posterior iliac crest graft was 11.8%. The failure rate in patients treated by interbody fusion with bicortical bone grafts was only 1.9%. The patients were ambulatory three to four days after the operation. In cases of spondylolysis and spondylolisthesis, interbody fusion should be coupled with some manner of posterior internal fixation. The extraction of two pieces of bicortical bone from the anterior iliac crest, measuring 1.2 cm or 1.3 cm by 2.5 cm, may cause weakness of the pelvic bone. Therefore, the bicortical grafting in PLIF should be limited to severely disabled patients with complete spinal canal stenosis or very large myelographic defects.
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PMID:Experience in posterior lumbar interbody fusion: unicortical versus bicortical autologous grafts. 388 91

There were 13 adults with spondylolisthesis treated operatively from 1994 to 1997 in University Orthopaedics Department in Lublin. The surgical procedures consisted of displacement reduction by transpedicular device and stabilization with Kluger's system. Patient's age ranged from 39 to 60 years. The follow-up examination took place 1 to 4 years from surgery. In 10 cases isthmal spondylolisthesis and in additional 3 iatrogenic (because of previous operations) were diagnosed. There was pathology on level L4/L5 in 6 and L5/S1 in other 7 patients. The first grade of displacement had 7 persons and the second one other 6. The vertebral body displacement ranged from 15% to 35%. All patients 3-6 months before admission had had pain intensification because of instability and nerve's roots irritation. Wide laminectomy with osteophytes removal from anterior wall od spinal canal gave chance to decompress neural structures. There were 3 patients who had posterior spondylodesis between transverse processes, 2 who had ALIF two weeks after operation from posterior approach. In 7 cases posterior intervertebral spondylodesis (PLIF) was performed during the same procedure with displacement reduction. Follow-up examination found full reduction and sufficient interbody fusion in all cases. In 1 patient there was transpedicular screw loosening because ALIF as the second step of procedure wasn't done. There was one deep infection and necessity of fixateur removal 9 months postop. The others hadn't symptoms of screw loosening and it suggests sufficient spondylodesis. Ten patients returned to their previous occupation.
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PMID:[The evaluation of preliminary results of spondylolisthesis treatment in adults by Kluger's transpedicular stabilization]. 1049 48

Pedicle screw fixation is technically demanding and associated with high complication rates. The aim of this study was to identify and quantify the pedicle screw-related complications in 105 consecutive operations. We retrospectively analysed 105 consecutive primary operations. We found complications of varying severity in 54% of the patients. Deep infections were found in 4.7%, all successfully cured by debridement and antibiotics. There were no permanent neurological complications related to the screws. One serious neurological sequela, a T10 paraplegia, was unrelated to screw placement between L3 and S1. Screw misplacement was found in 6.5% of the screws. Screw breakage occurred in 12.4% of the patients, inevitably leading to loss of correction. Reduced spondylolisthesis L5-S1 without anterior support was found to be especially prone to screw breakage. The study confirmed that pedicle screw placement is a technically demanding procedure with a high complication rate. Fortunately, most complications are not severe. Infections can be dealt with by thorough debridement and parenteral antibiotics. Neurological sequelae can be minimised by careful tactile technique. To avoid screw breakage and subsequent loss of correction, anterior support should be provided, through either posterior or anterior lumbar interbody fusion (PLIF or ALIF) techniques, in reduced spondylolisthesis L5-S1.
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PMID:Complications of pedicle screws in lumbar and lumbosacral fusions in 105 consecutive primary operations. 1252 19

Posterolateral fusion has long been considered the "gold standard" technique for surgical treatment of adult spondylolisthesis. Superior results have subsequently been reported with interbody fusion with cages and posterior instrumentation. The goal of this prospective study was to compare the two techniques regarding their clinical outcomes and fusion rates. Fifty-two patients with isthmic spondylolisthesis were operated by the same surgeon. One group (25 patients) had decompression and posterolateral fusion (PLF) with a pedicle screw system ; patients in the other group were treated by decompression, posterior interbody fusion (PLIF) and a pedicle screw system. The two groups were similar with respect to grade of slipping, age, and activity. Seventy-seven percent of the patients had a good or very good result with PLIF and 68% with posterolateral fusion. However, there was no statistical difference in cases with low grade slipping, whereas the difference was significant for cases with high grade slipping. The fusion rate was 93% with PLIF and 68% with PLF, but without any significant incidence on the functional outcome. Based on these findings, we now use posterior interbody fusion for high grade spondylolisthesis which requires reduction or if the disc space is still high. When the slip grade is low, or the disc space is narrow, we prefer posterolateral fusion.
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PMID:Posterolateral versus interbody fusion in isthmic spondylolisthesis: functional results in 52 cases with a minimum follow-up of 6 years. 1566 59

Transpedicular fixation systems are commonly used in lumbar spine surgery for the treatment of a variety of pathologies making the solid fusion of operated spinal segments possible. Recently there has been a big interest in minimally invasive techniques in spinal surgery, including minimally invasive fixation systems. By minimizing the operative trauma minimally invasive techniques allow patients to restore activity faster. In the paper the authors present the Sextant system (Medtronic Sofamor Danek), which provides minimally invasive (percutaneous) fixation. Before fixing the spine, it is necessary to perform discectomy and interbody fusion using the PLIF or ALIF method. The authors present the system, describe the operative technique, and present a case of the patient with L4/L5 spondylolisthesis successfully treated using this technique.
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PMID:[Minimally invasive percutaneous transpedicular lumbar spine fixation. Operative technique and a case report]. 1587 Oct 61

In high-grade spondylolisthesis, the surgical treatment should be aimed at achieving good stability to allow solid fusion in the face of high biomechanical forces at the lumbosacral junction. A 360 degrees fusion seems to be able to provide this stability. This is however extensive surgery and many problems and complications have been reported. In order to overcome these difficulties, various new procedures have been published. Most of these techniques aim for a good anterior column support, allowing primary stability and a large bony surface area for fusion. Transfixation of the lumbosacral disc space using a fibular strut graft was published decades ago. Several modifications have been reported since, including the use of threaded cages filled with bone graft. In contrast to the number of these surgical techniques, only few biomechanical test results and small-size clinical studies have been reported in the literature. An interesting technique of lumbosacral transfixation includes the use of transdiscal pedicle screws, described by Abdu et al in 1994. This allows for the use of standard instruments and implants, while biomechanical testing recently has shown improved stability equal to classic PLIF constructs by providing three-column support. Moreover, in high-grade slips this technique is easier to perform than other methods. We have treated four consecutive patients according to this technique with good clinical and radiographic results. The surgical technique is described in detail and a review of the literature is provided.
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PMID:Treatment of high-grade spondylolisthesis by posterior lumbosacral transfixation with transdiscal screws: surgical technique and preliminary results in four cases. 1603 8

The objective of this study was to evaluate which fusion technique provides the best clinical and radiological outcome for adult low-grade lumbar isthmic spondylolisthesis, and to assess the overall clinical and radiological outcome of each fusion technique. A systematic review was performed. Medline, Embase, Current Contents, and Cochrane databases as well as reference lists of selected articles were searched. Randomised controlled trials (RCTs) were used to evaluate the best treatment; controlled studies and non-controlled studies were used to determine the outcomes after surgery. Two independent reviewers evaluated the studies with the methodological checklists of van Tulder and Jadad for the randomised studies and of Cowley for the non-randomised studies. The search resulted in 684 references and eventually 29 studies met the inclusion criteria, of which eight were RCTs, four were prospective, and 17 were retrospective case series. Ten of the case series did not clearly identify consecutive patient selection. All the eight RCTs evaluated the effect of different techniques of posterolateral fusion (PLF). Evidence was found that the PLF was superior to non-operative treatment (exercise). Circumferential fusion was compared to PLF, but no difference could be found. PLF with or without instrumentation was evaluated in three studies, but no benefits from additional instrumentation were found. Other comparisons within PLF showed no effect of decompression, alternative instrumentation, or bone graft substitute. The 21 case series included 24 patient groups. PLF was used in 15 groups, good or excellent clinical outcome varied from 60 to 98% and fusion rate varied from 81 to 100%. Anterior interbody fusion was used in five groups, good or excellent clinical outcome varied from 85 to 94% and fusion rate varied from 47 to 90%. Posterior interbody fusion was used in two groups, good or excellent clinical outcome was 45% and fusion rate was 80 and 95%, respectively. Reduction, loss of reduction, and lordotic angles before and after the treatment was reported in only four studies. Average reduction achieved was 12.3%, average loss of reduction at follow-up was 5.9%. Preoperative lordotic angles were too heterogeneous to pool the results. Adjacent segment degeneration was not reported in any of the publications. A wide variety of complications were reported in 18 studies and included neurological complications, instrument failure, and infections. Fusion for low-grade isthmic spondylolisthesis has better outcomes than non-operative treatment. The current study could not identify the best surgical technique (PLF, PLIF, ALIF, instrumentation) to perform the fusion. However, instrumentation and/or decompression may play a beneficial role in the modern practice of reduction and fusion for low-grade isthmic spondylolisthesis, but there are no studies yet available to confirm this. The outcomes of fusion are generally good, but reports vary widely.
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PMID:Fusion for low-grade adult isthmic spondylolisthesis: a systematic review of the literature. 1621 65

Transpedicular screw fixation has been accepted worldwide since Harrington et al. first placed pedicle screws through the isthmus. In vivo and in vitro studies indicated that pedicle screw insertion accuracy could be significantly improved with image-assisted systems compared with conventional approaches. The O-arm is a new generation intraoperative imaging system designed without compromise to address the needs of a modern OR like no other system currently available. The aim of our study was to check the accuracy of O-arm based and S7-navigated pedicle screw implants in comparison to free-hand technique described by Roy-Camille at the lumbar and sacral spine using CT scans. The material of this study was divided into two groups, free-hand group (group I) (30 patients; 152 screws) and O-arm group (37 patients; 187 screws). The patients were operated upon from January to September 2009. Screw implantation was performed during PLIF or TLIF mainly for spondylolisthesis, osteochondritis and post-laminectomy syndrome. The accuracy rate in our work was 94.1% in the free-hand group compared to 99% in the O-arm navigated group. Thus it was concluded that free-hand technique will only be safe and accurate when it is in the hands of an experienced surgeon and the accuracy of screw placement with O-arm can reach 100%.
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PMID:Computer tomography assessment of pedicle screw placement in lumbar and sacral spine: comparison between free-hand and O-arm based navigation techniques. 2125 80

We present a novel, minimally invasive, navigation-guided approach for surgical treatment of degenerative spondylolisthesis (DS) that is a hybrid of the two most common techniques, posterior interbody fusion (PLIF) and transforaminal interbody fusion (TLIF). DS is an acquired condition with intersegmental instability of one or more lumbar motion segments. Seven patients with single level lumbar DS underwent lumbar arthrodesis utilizing the hybrid technique (HLIF) in our center. Using a standard unilateral midline approach a decompression and partial facetectomy on one side was performed, allowing for implantation of a specially designed interbody cage. Pedicle screws were placed using neuronavigation in a vertical vector on the side of the partial facetectomy and dorsolaterally (percutaneous) on the contralateral side. Patient and operative data, numeric rating scale (NRS) pain scores, core outcome measures index (COMI) and Oswestry disability index (ODI) were recorded preoperatively as well as 6 weeks, 3 months, 6 months and 1 year after surgery. All patients completed the 1 year follow-up. There was significant postoperative improvement of NRS, COMI and ODI scores at all postoperative follow-up time points (p<0.05). The radiological assessments of realignment showed a reduction of listhesis from an average of 21.04% (standard deviation [SD] 5.1) preoperatively to 9.14% (SD 4.0) postoperatively (p<0.001). The average blood loss was 492 ml. Post-procedure CT scans demonstrated correct implant placement in all but one patient who required a revision of a single pedicle screw. HLIF allows thorough decompression as well as realignment and interbody fusion for patients with DS and may help reduce tissue trauma in comparison to other minimally invasive lumbar fusion techniques.
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PMID:A novel minimally invasive technique for lumbar decompression, realignment, and navigated interbody fusion. 2610 Jan 55


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