A new lever reduction technique for the surgical treatment of elderly patients with lumbar degenerative Spondylolisthesis

Abstract

Background: Proper reduction method for Lumbar degenerative spondylolisthesis (LDS) is still controversial. The aim of this study was to determine the safety and effectiveness of lever reduction combined with traditional elevating-pull reduction technique for the treatment of elderly patients with LDS. Methods: From May 2015 to December 2017, 142 elderly patients (≥65 years) diagnosed with LDS were enrolled in this study with a mean follow-up of 25.42 ± 8.31 months. All patients were operated using lever reduction combined with traditional elevating-pull reduction technique. Patient age, sex, body mass index, bone mineral density, preoperative comorbidities, surgical duration, blood loss, and surgical complications were collected form patient charts. Clinical data as visual analog scale (VAS), Oswestry Disability Index (ODI), and 36-Item Short Form Health Survey (SF-36) were collected preoperatively, 1 month postoperatively, and at the final follow-up. Radiographic evaluation included slip percentage, slip angle (SA), lumbar lordosis (LL), and fusion status. Results: The clinical parameters of VAS back , VAS leg , ODI, and SF-36 had significantly improved at both followups after surgery. A significant improvement was indicated for slippage reduction at both follow-ups, showing no significant correction loss after surgery. SA significantly increased after surgery and was well maintained at the final follow-up. LL was not affected by the surgery. At the final follow-up, complete fusion was obtained in 121 patients (85.2%) and partial fusion in 21 (14.8%). Revision surgery was performed for one patient. Screw loosening was observed in 3 (2.11%) cases. No nerve root injury or adjacent segment disease was observed. Conclusions: This new lever reduction combined with traditional elevating-pull reduction technique for the surgical treatment of elderly patients with LDS is both safe and effective. Satisfactory correction and fusion rates were achieved with acceptable correction loss and reduction-related complications.

Fusion with and without lever reduction in degenerative lumbar spondylolisthesis: a retrospective study

“…However, the implementation of these methods relies upon adequate contact force between the instrumentation and vertebra and might instead result in implant-related complications, especially for elderly DLS patients with diminished bone quality. In response to these challenges, our clinical center introduced a novel lever reduction procedure in combination with transforaminal lumbar interbody fusion [ 14 ]. The present study compared the clinical efficacy, radiographic outcomes, and complications of in situ fusion versus fusion with lever reduction in a cohort of 281 patients.…”

“…Nonetheless, such negative effects were not evident in patients who underwent fusion with the lever reduction procedure in our research (Table 4 ). The lever device's distractive force can mitigate the pull force exerted on the instrumentation to some extent, potentially leading to fewer implant-related complications [ 14 ]. Considering these factors collectively, the superiority of fusion with lever reduction is primarily manifested in reducing the risk of complications rather than enhancing patient-reported outcomes.…”

“…The reduction of the slipped vertebra was conducted following lever reduction technique (Fig. 1 ) [ 14 ]. The extent of slip reduction was verified with fluoroscopy.…”

“…To reduce the surgical-related complications linked to the reduction procedure, we introduced a composite reduction technique encompassing both traditional elevating-pull reduction and innovative lever reduction. The clinical utility of this technique was previously demonstrated in case series [ 14 ]. This study aims to delve deeper into the clinical efficacy, radiological outcomes, and complications associated with fusion with or without lever reduction for DLS treatment.…”

Biomechanical analysis of reduction technique for lumbar spondylolisthesis: anterior lever versus posterior lever reduction method

“…In this procedure, the tip of a Hohmann retractor was positioned at the posterior rim of the upper endplate of the lower vertebrae, which was then used as a fulcrum to reduce the slippage of the spondylolisthesis. In contrast, Kong et al [ 14 ] have also developed a lever reduction technique that can achieve reduction with a lever repositioner via the posterior approach.…”