OBJECTIVE: To explore the clinical efficacy and safety of the "Three-Step Nine-Method Lumbar Correction" combined with physical therapy in the treatment of patients with degenerative lumbar spondylolisthesis(DLS). METHODS: From January 2021 to December 2021, 72 patients diagnosed with DLS were enrolled and divided into the Three-Step Nine-Method Lumbar Correction group and the pelvic traction group, with 36 cases in each group. In the Three-Step Nine-Method Lumbar Correction group, there were 15 males and 21 females;aged 54 to 66 years old, with an average of (59.07±5.69) years old;the course of disease was 14 to 26 years old, with an average of (20.35±5.66) years old. They were treated with the Three-Step Nine-Method Lumbar Correction combined with low-frequency physical therapy, 3 times a week, for a 4-week course. In the pelvic traction group, there were 12 males and 24 females;aged 54 to 66 years old, with an average of (59.69±5.59) years old;the course of disease was 13 to 26 years old, with an average of (19.74±5.80) years old. They were treated with pelvic traction combined with low-frequency physical therapy. Efficacy evaluation was conducted using the visual analogue scale(VAS), Oswestry disability index(ODI), Japanese Orthopaedic Association (JOA) score, and Short Form 36 Health Survey (SF-36) before treatment, after 2 and 4 weeks of treatment, and at the 8-week follow-up after the end of treatment. In addition, imaging parameters of paravertebral muscles were evaluated before treatment and at the completion of treatment. RESULTS: All 72 patients completed the follow-up for 8 weeks. At the 8-week follow-up after the end of treatment, in the Three-Step Nine-Method Lumbar Correction group, the VAS score for low back pain decreased from (6.25±1.23) points before treatment to (1.25±0.65) points, with a statistically significant difference (P<0.05);the ODI decreased from (57.17±7.13)% before treatment to (19.89±5.66)%, with a statistically significant difference (P<0.05);the JOA score and SF-36 score increased from (15.46±3.20) points and (35.25±9.28) points before treatment to (23.75±2.10) points and (62.31±13.03) points, respectively, with statistically significant differences (P<0.05). The improvement of each index in the Three-Step Nine-Method Lumbar Correction group was better than that in the pelvic traction group (P<0.05), but the change in imaging parameters was not significant (P>0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups (P>0.05), and no serious adverse events occurred. CONCLUSION The Three-Step Nine-Method Lumbar Correction combined with physical therapy has a definite efficacy in the treatment of DLS. It can significantly relieve pain symptoms, improve physical function and patients' quality of life. Its effect is better than that of pelvic traction combined with physical therapy, and it has high safety. However, its improvement on paravertebral muscles is not obvious.
Humans ; Male ; Female ; Middle Aged ; Spondylolisthesis/physiopathology* ; Aged ; Prospective Studies ; Lumbar Vertebrae/physiopathology* ; Physical Therapy Modalities ; Adult

OBJECTIVETo explore the clinical effect of transforaminal lumbar interbody fusion (with single cage) combined with unilateral pedicle screw fixation in treating lumbar instability.

METHODSThe clinical data of 50 patients with lumbar instability were retrospectively analyzed. They underwent treatment and obtained following up more than 8 months from 2009 to 2012. All patients complicated with refractory or recurrent lower back pain, and unilateral primarily or unilateral lower limb radiation pain, X-ray and CT films showed lumbar instability. The patients were respectively treated with transforaminal lumbar interbody fusion (with single cage) combined with unilateral or bilateral pedicle screw fixation. According to different fixation methods, they divided into unilateral fixation group and bilateral fixation group. There were 20 patients with 22 intervertebral spaces in unilateral fixation group, 8 males and 12 females, aged from 26 to 66 years old, 2 cases with isthmic spondylolisthesis of degree I, 8 cases with degenerative spondylolisthesis, 10 cases with lumbar disc herniation; fusion location with L3,4 was in 1 case, L4,5 was in 12 cases, L5S1 was in 9 cases. There were 30 patients with 30 intervertebral spaces in bilateral fixation group, 14 males and 16 females, aged from 41 to 62 years old, 4 cases with isthmic spondylolisthesis of degree I,14 cases with degenerative spondylolisthesis, 12 cases with lumbar disc herniation; fusion location with L3,4 was in 3 cases, L4,5 was in 15 case, L5S1 was in 12 cases. Operation time, intraoperative blood loss, postoperative drainage, complications were analyzed and intervertebral height, lordosis angle changes, fusion rate and clinical effect were compared between two groups.

RESULTSAll incisions obtained primary healing,lower limb radiation pain and low back pain disappeared basically, no infection, endorachis injury was found. Foot drop occurred in one case of bilateral fixation group and no iatrogenic neurological symptom was found in unilateral fixation group. All patients were followed up from 8 to 18 months with an average of (10.8?4.3)months. Ac- cording to JOA score improvement rate (RIS) to assess clinical effect, all patients got excellent and good results, there was no statistically significant difference between two groups. Two methods can both effectively increase the pathological intervertebral height. Unilateral fixation group was better than bilateral fixation group in aspect of operation time, intraoperative blood loss and postoperative drainage.

CONCLUSIONWith strict indication and good skills, transforaminal lumbar interbody fusion (with single cage) combined with unilateral pedicle screw fixation in treating lumbar instability has advantages of smaller traumatic, less blood loss, faster recovery for the patient and can reduce the economic cost.

Adult ; Aged ; Combined Modality Therapy ; Female ; Humans ; Intervertebral Disc Displacement ; physiopathology ; surgery ; Lumbar Vertebrae ; surgery ; Male ; Middle Aged ; Pedicle Screws ; Retrospective Studies ; Spinal Fusion ; methods ; Spondylolisthesis ; physiopathology ; surgery

OBJECTIVETo analyze the surgical failure of lumbar spondylolisthesis and investigate the clinical effect of three vertebral reduction and fixation in revision of lumbar spondylolisthesis.

METHODSThe clinical data of 19 patients underwent revision to lumbar spondylolisthesis was retrospectively analyzed between January 2009 and December 2012. There were 12 males and 7 females, aged from 36 to 68 years old with an average of 51.5 years. Reduction loss of olisthy segment had in 6 cases, internal fixation loosening or breakage had in 5 cases, slippage aggravating had in 8 cases. Clinical symptoms including lower back pain, unilateral or bilateral lower extremity pain and numbness, etc. Revision surgery was performed with three vertebral pedicle screw internal fixation and posterior decompression, reduction, and posterolateral bone graft between vertebral body. For the first time after surgery pedicle screw loosening or fracture of vertebral body, to switch thick or long pedicle screws implanted into again, or with bone cement perfusion and implanted with pedicle. The condition of intervertebral fusion and clinical effect were respectively assessed by X-ray films and JOA score.

RESULTSAll patients were followed up from 10 to 30 months with an average of 18 months. X-ray showed all bone graft obtained fusion and fusion time was from 5.5 to 7 months after revision. No pedicle screws loosening and breakage were found and no reduction loss vertebral body. JOA score were statistically analyzed between preoperative and postoperative at 6 months, in 3 cases with degree I, the score respectively was 13.33 ± 1.53 and 26.33 ± 0.58; in 7 cases with degree II, the score respectively was 12.85 ± 2.19 and 26.29 ± 2.21; in 9 cases with degree III, the score respectively was 12.21 ± 2.73 and 26.44 ± 1.81; there was statistical significance between preoperative and postoperative at 6 months, the improvement rate of JOA was (78.06 ± 3.90)%.

CONCLUSIONFor the patients with lumbar spondylolisthesis, the reason of primary surgical failure mainly concerned with internal fixation loosening and breakage, and bone graft no-fusion. Revision surgery using three vertebral pedicle screw internal fixation, can get rigid fixation, complete decompression, bone graft fusion, combined with the guidance of the postoperative functional exercise for patients, can obtain satisfactory therapeutic effects.

Adult ; Aged ; Decompression, Surgical ; Female ; Humans ; Lumbar Vertebrae ; physiopathology ; surgery ; Male ; Middle Aged ; Pedicle Screws ; Retrospective Studies ; Spinal Fusion ; methods ; Spondylolisthesis ; physiopathology ; surgery

Decompression, Surgical ; Humans ; Lumbar Vertebrae ; surgery ; Spinal Fusion ; Spondylolisthesis ; diagnosis ; physiopathology ; surgery

A 35 years old female presented to us after falling from a height. She complained of a neck pain and a complete quadriplegia and was diagnosed as having spondyloptosis of the C6-C7. Skeletal traction was performed on her. CT scan showed fractures of the C5, C6, and C7 vertebral body. The patient underwent anterior approach partial corpectomy with anterior cervical locking plate and strut grafting from ipsilateral iliac crest. Intraoperatively it was found that the disc was completely ruptured and there was a dural tear and cerebrospinal fluid leak. Her postoperative period was complicated by cerebrospinal fluid collection and posterior instrumentation was not performed due to the poor general condition. She had no neural recovery at the last follow-up. Spondyloptosis is a severe and highly unstable injury with a three column ligamentous disruption and may be complicated, as in our case, with a dural tear. Management of these cases is fraught with complications, and prognosis for neural recovery is dismal.
Adult ; Female ; Humans ; Magnetic Resonance Imaging ; Spondylolisthesis ; diagnosis ; physiopathology ; surgery

Adult ; Aged ; Female ; Follow-Up Studies ; Humans ; Internal Fixators ; Lumbar Vertebrae ; diagnostic imaging ; pathology ; physiopathology ; surgery ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Recovery of Function ; Spondylolisthesis ; diagnostic imaging ; physiopathology ; surgery ; Tomography, X-Ray Computed

OBJECTIVETo explore internal fixation whether can improve the clinical outcomes of decompression and posterolateral fusion in patients with degenerative lumbar spondylolisthesis.

METHODSFrom December 1998 to December 2005, 49 patients who had degenerative lumbar spondylolisthesis underwent decompression and posterolateral fusion without (group A, 21 cases) or with (group B, 28 cases) internal fixation (CD HORIZON M8 system). There were 12 males and 37 females with a mean age of 58.5 years (range, from 49 to 68 years). Among them,32 cases were grade I and 17 were grade II according to Meyerding grade system. All patients were followed up with an average of 58 months (range from 12 to 90 months). The pain of low back and leg (VAS scoring), spinal active function and neurologic function were evaluated according the assessment system of Yuan.

RESULTSThe VAS score of low back in group A and B were respectively 41.9 +/- 7.5 and 32.8 +/- 6.2 at follow-up; and VAS score of leg in group A and B were respectively 33.9 +/- 7.3 and 30.8 +/- 6.2. Spinal active function of patients, 15 cases obtained improvement, 6 cases aggravation or no improvement in group A; 25 cases obtained improvement, 3 cases aggravation or no improvement in group B. Neurologic function of patients, 15 cases obtained improvement, 6 cases aggravation or no improvement in group A; 26 cases obtained improvement, 2 cases aggravation or no improvement in group B. The group B was better than group A in the aspect of low back pain, spine active function and neurologic function (P < 0.05). There was no statistically significant difference in improvement of leg pain between two groups (P > 0.05).

CONCLUSIONUsing internal fixation in decompression and posterolateral fusion for degenerative lumbar spondylolisthesis can improve low back pain and clinical function. Decompression is necessary for the surgical treatment of degenerative spondylolisthesis, which is major effect on the improvement of leg pain.

Aged ; Bone Screws ; Female ; Follow-Up Studies ; Humans ; Lumbar Vertebrae ; pathology ; physiopathology ; surgery ; Male ; Middle Aged ; Recovery of Function ; Retrospective Studies ; Spinal Fusion ; methods ; Spondylolisthesis ; physiopathology ; surgery ; therapy ; 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

Combined Modality Therapy ; Humans ; Lumbar Vertebrae ; pathology ; physiopathology ; surgery ; Spondylolisthesis ; diagnosis ; physiopathology ; surgery ; therapy