OBJECTIVE: To compare the effectiveness of robot-assisted minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and open freehand TLIF for the treatment of single-level degenerative lumbar spondylolisthesis (DSL) and analyse the influence on postoperative adjacent segmental degeneration (ASD). METHODS: The clinical data of 116 patients with L _4、5 DLS who were admitted between November 2019 and October 2021 and met the selection criteria were retrospectively analyzed. According to the surgical methods, they were divided into the robotic group (45 cases, who underwent robot-assisted MIS-TLIF) and the open group (71 cases, who underwent open freehand TLIF). There was no significant difference in baseline data such as gender, age, body mass index, DLS Meyerding grading, and preoperative Pfirrmann grading, Weishaupt grading, L _{3, 4} intervertebral disc height (DH), L _{3, 4} intervertebral mobility, sagittal parameters [including pelvic incidence (PI), lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT)], and Cage height ( P>0.05). The grade of facet joint violation (FJV) by pedicle screws on the superior articular process was assessed postoperatively. Sagittal parameters, L _{3, 4} DH, L _{3, 4} DH loss, and L _{3, 4} intervertebral mobility were measured preoperatively and at last follow-up in order to determine whether ASD occurred. Based on the occurrence of postoperative ASD, logistic regression analysis was used to identify the risk factors for ASD after TLIF. RESULTS: Patients in both groups were followed up 21-47 months, with a mean of 36.1 months; there was no significant difference in the follow-up time between the two groups ( P>0.05). The occurrence of postoperative FJV was significantly better in the robotic group than in the open group ( P<0.05). At last follow-up, the difference in the change values of sagittal parameters PI, PT, SS, and LL was not significant when comparing the two groups of patients ( P>0.05); the change values of L _{3, 4} DH and L _{3, 4} DH loss in the robotic group were smaller than those in the open group, and the change value of L _{3, 4} intervertebral mobility was larger than that in the open group, and the differences were significant ( P<0.05). At last follow-up, ASD occurred in 8 patients (17.8%) in the robotic group and 35 patients (49.3%) in the open group, and the difference in ASD incidence between the two groups was significant ( P<0.05). logistic regression analysis showed that open surgery, preoperative Pfirrmann grading Ⅳ-Ⅴ, preoperative Weishaupt grading ≥2, and postoperative FJV grading ≥1 were risk factors for the development of ASD after TLIF ( P<0.05). CONCLUSION Compared with traditional open surgery, orthopedic robot-assisted MIS-TLIF in the treatment of single-level DLS can more accurately insert pedicle screws, reduce the loss of DH and the occurrence of FJV, and effectively reduce the incidence of mid-postoperative ASD. Preoperative disc and synovial joint degeneration in adjacent segments, nonrobotic-assisted minimally invasive therapy, and FJV are risk factors for ASD after TLIF.
Humans ; Spinal Fusion/methods* ; Spondylolisthesis/surgery* ; Lumbar Vertebrae/surgery* ; Minimally Invasive Surgical Procedures/methods* ; Robotic Surgical Procedures/methods* ; Male ; Treatment Outcome ; Female ; Intervertebral Disc Degeneration/surgery* ; Retrospective Studies ; Postoperative Complications/etiology* ; Risk Factors ; Middle Aged

Spondyloptosis in the clinic is rarely reported. We herein present a 47-year-old female, who suffered from a crush injury directly by a heavy cylindrical object from the lateral side. She was diagnosed to have traumatic L₃ spondyloptosis with multiple traumas. Staged surgical procedures were conducted and a three-year follow-up was obtained. Eventually, normal spinal alignment was restored, and neurological deficits were gradually improved. At three years follow-up, the motor strength scores and function of the sphincters were incompletely improved. Previously published reports on traumatic lumbar spondyloptosis were reviewed and several critical points for management of this severe type of spinal injury were proposed. First, thoracolumbar and lumbosacral junction were mostly predilection sites. Second, numerous patients involving traumatic lumbar spondyloptosis were achieved to American Spinal Injury Association grade A. Third, lumbar spondyloptosis was commonly coupling with cauda equina injury. Finally, the outcomes were still with poorly prognosis and recovery of patients was correlation to spondyloptosis severity. Based on this case report and literatures review, we highlighted that the spinal alignment restoration relying on staged operations and following rehabilitation hereof are both important once facing with multiple traumas. Furthermore, we suggested to perform routine CT angiography during lumbar spondyloptosis to justify whether there are large vessel compression or injury.
Female ; Humans ; Middle Aged ; Lumbar Vertebrae/injuries* ; Spondylolisthesis/surgery* ; Spinal Injuries ; Multiple Trauma/complications*

BACKGROUND: To evaluate the effect of spondylolisthesis on lumbar lordosis on the OSI (Jackson; Orthopaedic Systems Inc.) frame. Restoration of lumbar lordosis is important for maintaining sagittal balance. Physiologic lumbar lordosis has to be gained by intraoperative prone positioning with a hip extension and posterior instrumentation technique. There are some debates about changing lumbar lordosis on the OSI frame after an intraoperative prone position. We evaluated the effect of spondylolisthesis on lumbar lordosis after an intraoperative prone position. METHODS: Sixty-seven patients, who underwent spinal fusion at the Department of Orthopaedic Surgery of Gwangmyeong Sungae Hospital between May 2007 and February 2012, were included in this study. The study compared lumbar lordosis on preoperative upright, intraoperative prone and postoperative upright lateral X-rays between the simple stenosis (SS) group and spondylolisthesis group. The average age of patients was 67.86 years old. The average preoperative lordosis was 43.5degrees (+/- 14.9degrees), average intraoperative lordosis was 48.8degrees (+/- 13.2degrees), average postoperative lordosis was 46.5degrees (+/- 16.1degrees) and the average change on the frame was 5.3degrees (+/- 10.6degrees). RESULTS: Among all patients, 24 patients were diagnosed with simple spinal stenosis, 43 patients with spondylolisthesis (29 degenerative spondylolisthesis and 14 isthmic spondylolisthesis). Between the SS group and spondylolisthesis group, preoperative lordosis, intraoperative lordosis and postoperative lordosis were significantly larger in the spondylolisthesis group. The ratio of patients with increased lordosis on the OSI frame compared to preoperative lordosis was significantly higher in the spondylolisthesis group. The risk of increased lordosis on frame was significantly higher in the spondylolisthesis group (odds ratio, 3.325; 95% confidence interval, 1.101 to 10.039; p = 0.033). CONCLUSIONS: Intraoperative lumbar lordosis on the OSI frame with a prone position was larger in the SS patients than the spondylolisthesis patients, which also produced a larger postoperative lordosis angle after posterior spinal fusion surgery. An increase in lumbar lordosis on the OSI frame should be considered during posterior spinal fusion surgery, especially in spondylolisthesis patients.
Aged ; Aged, 80 and over ; Female ; Humans ; Intraoperative Care/*methods ; Lumbar Vertebrae/*surgery ; Male ; Middle Aged ; Postoperative Complications/*prevention & control ; Posture/physiology ; Prone Position/*physiology ; Retrospective Studies ; Spinal Stenosis/*surgery ; Spondylolisthesis/*surgery

BACKGROUND: There are few studies about risk factors for poor outcomes from multi-level lumbar posterolateral fusion limited to three or four level lumbar posterolateral fusions. The purpose of this study was to analyze the outcomes of multi-level lumbar posterolateral fusion and to search for possible risk factors for poor surgical outcomes. METHODS: We retrospectively analyzed 37 consecutive patients who underwent multi-level lumbar or lumbosacral posterolateral fusion with posterior instrumentation. The outcomes were deemed either 'good' or 'bad' based on clinical and radiological results. Many demographic and radiological factors were analyzed to examine potential risk factors for poor outcomes. Student t-test, Fisher exact test, and the chi-square test were used based on the nature of the variables. Multiple logistic regression analysis was used to exclude confounding factors. RESULTS: Twenty cases showed a good outcome (group A, 54.1%) and 17 cases showed a bad outcome (group B, 45.9%). The overall fusion rate was 70.3%. The revision procedures (group A: 1/20, 5.0%; group B: 4/17, 23.5%), proximal fusion to L2 (group A: 5/20, 25.0%; group B: 10/17, 58.8%), and severity of stenosis (group A: 12/19, 63.3%; group B: 3/11, 27.3%) were adopted as possible related factors to the outcome in univariate analysis. Multiple logistic regression analysis revealed that only the proximal fusion level (superior instrumented vertebra, SIV) was a significant risk factor. The cases in which SIV was L2 showed inferior outcomes than those in which SIV was L3. The odds ratio was 6.562 (95% confidence interval, 1.259 to 34.203). CONCLUSIONS: The overall outcome of multi-level lumbar or lumbosacral posterolateral fusion was not as high as we had hoped it would be. Whether the SIV was L2 or L3 was the only significant risk factor identified for poor outcomes in multi-level lumbar or lumbosacral posterolateral fusion in the current study. Thus, the authors recommend that proximal fusion levels be carefully determined when multi-level lumbar fusions are considered.
Aged ; Female ; Humans ; Lumbar Vertebrae/surgery ; Lumbosacral Region ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors ; Scoliosis/complications/surgery ; Spinal Fusion/methods ; Spinal Stenosis/complications/diagnosis/*surgery ; Spondylolisthesis/complications/surgery ; Treatment Outcome

Development of anesthesiology and improvement of surgical instruments enabled aggressive surgical treatment even in elderly patients, who require more active physical activities than they were in the past. However, there are controversies about the clinical outcome of spinal surgery in elderly patients with spinal stenosis or spondylolisthesis. The purpose of this study is to review the clinical outcome of spinal surgery in elderly patients with spinal stenosis or spondylolisthesis. MEDLINE search on English-language articles was performed. There were 39685 articles from 1967 to 2013 regarding spinal disease, among which 70 dealt with geriatric lumbar surgery. Eighteen out of 70 articles dealt with geriatric lumbar surgery under the diagnosis of spinal stenosis or spondylolisthesis. One was non-randomized prospective, and other seventeen reports were retrospective. One non-randomized prospective and twelve out of seventeen retrospective studies showed that old ages did not affect the clinical outcomes. One non-randomized prospective and ten of seventeen retrospective studies elucidated postoperative complications: some reports showed that postoperative complications increased in elderly patients, whereas the other reports showed that they did not increase. Nevertheless, most complications were minor. There were two retrospective studies regarding the mortality. Mortality which was unrelated to surgical procedure increased, but surgical procedure-related mortality did not increase. Surgery as a treatment option in the elderly patients with the spinal stenosis or spondylolisthesis may be reasonable. However, there is insufficient evidence to make strong recommendations regarding spinal surgery for geriatric patients with spinal stenosis and spondylolisthesis.
Aged ; Aged, 80 and over ; Constriction, Pathologic ; Decompression, Surgical/*methods ; Female ; Humans ; *Lumbar Vertebrae ; Male ; Patients ; Postoperative Complications/diagnosis ; Spinal Stenosis/*surgery ; Spondylolisthesis/*surgery ; Surgical Instruments ; Treatment Outcome

OBJECTIVETo investigate the effect of treating degenerative lumbar spondylolisthesis by transforaminal lumbar interbody fusion with microendoscopic surgery.

METHODSFrom Jan. 2006 to Jan. 2009, one hundred fifty patients who underwent transforaminal lumbar interbody fusion with microendoscopic surgery were analyzed retrospectively. The diagnosis was degenerative lumbar spondylolisthesis in 84 cases of grade I, and 66 cases of grade II. There were 88 males and 62 females. Preoperatively, at 1 week and 3 months postoperatively, the pain was evaluated with visual analogue scale (VAS) scoring system and therapeutic effect was observed with modified Prolo scoring system.

RESULTSIn complications, dural tear happened in 3 cases, biological glues were used for dural tear sealing and neither cerebrospinal fluid leak was found. One case suffered from intervertebral Infection and muscle weakness of foot was found in one case, either was cured after symptomatic treatment. Operative time averaged 160 minutes (120-280 min). Estimated blood loss averaged 210 ml (100-450 ml). The postoperative follow-up ranged from 6 to 36 months (averaged 15.2 months). Preoperatively,at 1 week and 3 months postoperatively, VAS scores were respectively 7.9 +/- 2.1, 2.2 +/- 0.6, 3.2 +/- 1.1 (P < 0.01). The rate of excellent and good was 98.67% (148/150) according to modified Prolo scoring system.

CONCLUSIONMicroendoscopic surgery transforaminal lumbar interbody fusion technique is indicated for lumbar vertebral instability, localized intervertebral disc disorder and lumbar spondylolisthesis with stenotic nerve root or tube below grade II. This technique has advantages of minimal invasion and early functional recovery.

Adult ; Aged ; Endoscopy ; adverse effects ; methods ; Female ; Follow-Up Studies ; Humans ; Lumbar Vertebrae ; pathology ; physiopathology ; surgery ; Male ; Middle Aged ; Postoperative Complications ; etiology ; Recovery of Function ; Retrospective Studies ; Spinal Fusion ; adverse effects ; methods ; Spondylolisthesis ; diagnostic imaging ; physiopathology ; surgery ; therapy ; Tomography, X-Ray Computed

Humans ; Lumbar Vertebrae ; diagnostic imaging ; pathology ; physiopathology ; surgery ; Postoperative Complications ; etiology ; Soft Tissue Injuries ; etiology ; Spondylolisthesis ; complications ; diagnostic imaging ; physiopathology ; surgery ; Tomography, X-Ray Computed

OBJECTIVETo study the causes of failure in the treatment of lumbar spondylolisthesis, and revision techniques and therapeutic effects.

METHODSEight cases with failed spondylolisthesis surgery were treated. There were 3 male and 5 female with an average age of 54 years old,ranging from 42 to 71 years. Among them, there were 6 cases of pedicle screws breakage, 1 case of fusion cage sinking and pedicle screws breakage, 1 case of osteoporosis and pedicle screws loosening. Their clinical symptoms included deformity, local pain, leg pain and numbness. The revision surgery was performed by the posterior decompression, instrumentation,intervertebral and posterolateral bone grafting, in which large diameter or long screws were applied for pedicle screws fixation.

RESULTSAll cases were followed-up from 6 to 24 months after revision(mean, 16 months). The clinical result was satisfied and the excellent or good results were 87.5%. There was no infection and other major complications. All patients had achieved solid fusion.

CONCLUSIONPoor technique and skill are considered as the primary causes leading to surgical failure of lumbar spondylolisthesis. The satisfactory outcome could be obtained by appropriately using the revision techniques.

Adult ; Aged ; Female ; Humans ; Lumbar Vertebrae ; surgery ; Male ; Middle Aged ; Postoperative Complications ; etiology ; Spinal Fusion ; Spondylolisthesis ; surgery ; Treatment Failure

OBJECTIVETo evaluate the therapeutic effects of lumbar spondylolisthesis by decompression, instrumentation and posterolateral fusion, and study the causes of the related complications and its method for the prevention.

METHODSOne hundred and sixty-five cases with grade I to II spondylolisthesis from February 1991 to May 2007 were retrospectively analyzed. All cases were treated by posterior lumbar canal decompression, reduction with pedicle screw system and fusion with posterolateral bone grafting. Among them,there were 55 male and 110 female with an average age of 53.6 years. Besides, one segment was involved in 161 cases and two segments involved in the rest of them.

RESULTSThe complications were divided into either intraoperative postoperative complications. Intraoperative complications were 5 cases (3.0%) there were 4 cases with dura tear and 1 case with nerve root injury. Postoperative complications were 18 cases (10.9%), there were 3 cases with cerebrospinal fluid leakage, 1 case with wound infection, 2 cases with hematoma,5 cases with transient neurological deficits, 1 cases with implant failures and 6 cases with pseudarthrosis formation.

CONCLUSIONGood clinical results of lumbar spondylolisthesis can be obtained by posterior reduction and fixation with pedicle screw system. However,operation skills and strict indications play an important role in the prevention of complications.

Adolescent ; Adult ; Aged ; Female ; Humans ; Internal Fixators ; Intraoperative Complications ; prevention & control ; Lumbar Vertebrae ; surgery ; Male ; Middle Aged ; Postoperative Complications ; prevention & control ; Retrospective Studies ; Spondylolisthesis ; surgery

Spinal instrumentation is a common method for the treatment of spinal disorders, but it can lead to the changes of spine biomechanics. Because of the stress changes, accelerated degeneration of the adjacent segment may occur as time goes by, namely adjacent segment disease. The accelerated degeneration can lead to secondary spinal stenosis, articulated joint degeneration, acquired spondylolisthesis, and spine instability, and some patients may have to receive surgery again. In recent years, the researchers gradually recognized the importance of this disease, and began to investigate its pathogenesis and management.
Humans ; Joint Instability ; etiology ; prevention & control ; Postoperative Complications ; diagnosis ; prevention & control ; Spinal Diseases ; surgery ; Spinal Fusion ; adverse effects ; instrumentation ; Spinal Stenosis ; etiology ; prevention & control ; Spondylolisthesis ; etiology ; prevention & control