A Case study of High Grade Spondylolisthesis (Grade III and Grade IV of Meyerding System) treated by Posterior Lumbar Interbody Fusion

Pathi Arasa Kumar, D (2007) A Case study of High Grade Spondylolisthesis (Grade III and Grade IV of Meyerding System) treated by Posterior Lumbar Interbody Fusion. Masters thesis, Madurai Medical College, Madurai.


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INTRODUCTION: The term spondylolisthesis is derived from Greek word (spondylos – vertebra, olisthesis – to slip or slide down a slippery path). It is defined as anterior or posterior slipping of one vertebra on another. Herbineaux, a Belgian obstetrician was the first to identify it. But the term was first coined by Killian. Prevalence of spondylolisthesis in general population is 5% and is equal in male and female. Depending on the grade of slip it is graded as grade I to grade IV. High grade slips definitely needs surgical intervention. Numerous treatment options have been recommended for the treatment of high grade slips. Treatment options include instrumented reduction and achieving fusion by means of any one of the following techniques such as 1. Anterior Lumbar Interbody Fusion (ALIF), 2. Transforaminal Lumbar Interbody Fusion (TLIF), 3. Posterior Lumbar Interbody Fusion (PLIF), 4. Anterior Fusion and Release with posterior fusion (360° fusion). All these have produced varying degree of success and contributed their own share of complications. We took the option of PLIF with MOSS MIAMI system of rods and screws with stainless steel cage packed with autologous bone graft and evaluated the results for correction of percentage slip. AIM: The purpose of this study is to evaluate decompression, reduction and instrumentation for high grade spondylolisthesis with posterior lumbar interbody fusion technique in 1. Alleviating clinical symptoms and signs of mechanical back pain and radicular pain with or without neurological deficit. 2. Achieving the correction of the % slip. 3. Avoiding the progression of slip. MATERIALS AND METHODS: We operated upon 15 patients with high grade spondylolisthesis at our institution, 11 were females and 4 were males. We used Meyerding system of grading in our series and patients in our study belonged to Grade III and Grade IV spondylolisthesis. 12 patients belonged to grade III and 3 belonged to grade IV of Meyerding’s system. Age of the patients ranged from 35-55 yrs. The period of study was from June 2004 to June 2006. All patients were followed regularly and the average period of follow up was 14 months. All our patients came under the category of isthmic type of spondylolisthesis. All our patients had unremitting back pain, leg pain with or without neurological deficit (EHL weakness Grade 4/5 in 3 cases). Dynamic plain radiography of all our patients showed spinal instability. Patients with low grade spondylolisthesis (Meyerding Grade I and II) and spondyloptosis were excluded from our study. Implants used were MOSS Miami system of rods, 5mm pedicle screws (mono axial, poly axial), stainless steel cage. RESULTS: The operating time was calculated from the start of surgical incision to wound closure and had not changed significantly throughout the study period. It was about 3.5 hrs. The blood loss was calculated from the number of surgical mops used each corresponding to 50ml. Blood loss in our series was about 220ml. The duration of image intensifier usage was calculated in seconds. It varied from 50-100 seconds. All patients were followed up for an average period of 14 months and the results were analysed. Clinically by alleviation of back pain and radicular pair. Radiologically by the correction of % slip. No case of infection was noticed in the postoperative period which might probably be due to the strict sterile technique followed preoperatively and 2 doses of broad. Spectrum antibiotics used, one dose, 2 hrs before surgery and another dose during the middle of the surgical procedure. We didn’t encounter any neurological deficit in our patients post operatively and the three patients who had motor weakness of Extensor Hallucis Longus (EHL) Grade 3/5 were also normalised to 5/5 after an average period of 8 weeks. CONCLUSION: Although this study is limited by few number of patients and the duration of follow up is very short, the outcomes suggest that the management of high grade listhesis can be accomplished successfully with PLIF technique. In conclusion, we would suggest PLIF technique supplemented with posterolateral bone grafting is an ideal technique in high grade listhesis for the achievement of 1. Reduction 2. Direct decompression of nerve roots 3. Interbody fusion 4. Good biomechanical support by pedicular instrumentation This technique is also advisable in view of low complication rate.

Item Type: Thesis (Masters)
Uncontrolled Keywords: High Grade Spondylolisthesis ; Grade III and Grade IV of Meyerding System ; Posterior Lumbar Interbody Fusion.
Subjects: MEDICAL > Orthopaedics
Depositing User: Subramani R
Date Deposited: 16 Sep 2017 15:16
Last Modified: 17 Sep 2017 02:59
URI: http://repository-tnmgrmu.ac.in/id/eprint/2935

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