Lever reduction using polyaxial screw and rod fixation system for the treatment of degenerative lumbar spondylolisthesis with spinal stenosis: technique and clinical outcome

Abstract

BackgroundThe management for degenerative lumbar spondylolisthesis with spinal stenosis remains controversial. Reduction of lumbar spondylolisthesis has been performed via numerous techniques. Most of them need extra reduction assembly.MethodsIn this retrospective analysis, 27 patients of degenerative lumbar spondylolisthesis with spinal stenosis underwent reduction using polyaxial screw and rod constructs and posterolateral fusion. The average age at the time of surgery was 53 ± 3.23 years. The outcome measures consisted of a radiographic assessment of deformity and fusion rate and a clinical assessment of perioperative improvement in low back pain and function. Preoperative and postoperative radiographic evaluation included the percent slip, slip angle, and the lumbar lordosis between L1 and the sacrum measured using the Cobb method. Before surgery and at the final follow-up, the Oswestry Disability Index (ODI) and the visual pain analog scale (VPAS) between 0 (no pain) and 10 (maximal pain) were quantified.ResultsThe average follow-up period more than 5 years was available. The mean operative time was 90.19 ± 14.51 min, and the mean blood loss during surgery was 152.59 ± 45.71 ml. The mean length of incision was 4.83 ± 0.63 cm. The average percent slippage and the mean slip angle were, respectively, 19.8 ± 4.49% and 9.69 ± 3.79° before surgery, 5.09 ± 3.40% and 6.39 ± 3.16° after surgery, and 5.67 ± 3.92% and 7.21 ± 3.05° at the last follow-up. The average lumbar lordosis was 36.88 ± 2.64° before surgery, 41.96 ± 1.64° after surgery, and 40.27 ± 1.19° at the final follow-up. No neurologic deficit occurred. Solid fusion was achieved for all cases. Compared with the outcome preoperation, the data improved from 6.56 ± 1.40 to 2.48 ± 1.16 for VPAS pain scores and from 32.22 ± 3.57 to 10.93 ± 4.93 for the ODI at the final follow-up.ConclusionsLever slip reduction maneuver techniques using polyaxial screw and rod fixation system was simple and practicable. The treatment outcomes showed satisfactory radiographic characteristics and clinical results. The length of the incision was relatively small with a low intraoperative blood loss and short operation time.

A modified jaslow-transforaminal lumbar interbody fusion for the treatment of isthmic spondylolisthesis

“…For the follow-up of over 2-year duration, the patients exhibited significantly reduced slippage percentage and increased IH, and modestly modified SA and LA. Despite the insignificant alterations of SA and LA in our study, our results were non-inferior to those with significant changes on grounds of our similar clinical outcomes (24,28).…”

“…Surgery for IS involves neurological decompression and sagittal spinal balance reconstruction, with reversal of the lumbosacral deformity achieved by reduction maneuvers. A number of surgical techniques can reportedly achieve reduction of lumbar IS (10,15,22,24,27,36,37). The insertand-rotate posterior lumbar interbody fusion (PLIF) technique, which employed autogenous spinous process, was first technique.…”

A Biomechanical Stability Study of Extraforaminal Lumbar Interbody Fusion on the Cadaveric Lumbar Spine Specimens

“…TLIF surgery as the classic fusion technique mainly focuses on decompressing lateral spinal canal. The stenosis of which is mainly caused by a great reduction in intervertebral height and intervertebral disc herniation, especially with relative cohesion and hyperplasia of superior facet joints [23, 24]. In most cases, the change of inferior articular process is not the etiological cause for lateral spinal canal stenosis.…”

The Use of Titanium Mesh for Defect Closure After Posterior Spinal Decompression

“…Bone fusion eliminates any pathologic movements, thereby removing the source of pain. 11,14 Decompression of neural structures followed by spinal fusion (with or without hardware fixation) has been considered the "gold standard" in the treatment of degenerative disorders of lumbar spine for the last two decades. 15,16 Spinal instrumentation has been widely used for several decades to ensure the stability of the spine.…”