Analysis of in Situ Posterior Spinal Fusion with Pedicle Screws and Rods in Grade I and Grade II Isthmic and Degenerative Spondylolisthesis

Sarath Babu, A N (2010) Analysis of in Situ Posterior Spinal Fusion with Pedicle Screws and Rods in Grade I and Grade II Isthmic and Degenerative Spondylolisthesis. Masters thesis, Madras Medical College, Chennai.


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INTRODUCTION: Spondylolisthesis is derived from the Greek word “spondylos” (vertebra) and “olisthesis “(to slip or fall). Spondylolisthesis is defined as the forward slippage of a cephalad vertebra on a caudal vertebra. The term spondylolisis is also derived from the Greek word “lysis” (loosening). Spondylolisthesis is now specifically used to describe a bony defect in the pars interarticularis, the portion of the neural arch joining caudal to the confluence of the pedicle and the superior articular process and at the most cephalad part of the lamina and the inferior articular process. Spondylolisthesis can be present with or without lysis. Spondylolisthesis is present in 5% of the adult population with clinical evidence of low back pain. These patients are treated initially by conservative measures, failing of which surgical intervention is mandatory. Numerous studies prove that reduction of severe high grade spondylolisthesis is essential, whereas low grade listhesis depending on the etiology, can be managed by several methods like direct repair of the pars defect in lysis patients or instrumented posterolateral fusion in situ with or without decompression. AIM: The aim of the study is to analyse the results of in situ posterior spinal fusion with pedicle screws and rods in Gr1 and Gr 2 L4-L5 and L5-S1 isthmic and degenerative spondylolisthesis. MATERIALS AND METHODS: This is a prospective study of 22 patients carried out in the Institute of Orthopaedics, Government General Hospital, Chennai from June 2007 to April 2009. Out of the 22 patients, 19(86.36%) were females and 3(13.63%) were males. The mean age of the patients were 45 years. Out of 22 patients, 11(50%) patients had listhesis at L4 – L5 level and another 11(50%) at L5 – S1 level. 19(86.36%) were Isthmic variant and 3 (13.63%) were Degenerative spondylolisthesis. The cases included in our study are isthmic and degenerative type of spondylolisthesis. Dysplastic and traumatic listhesis were excluded from our study. Also patients under age 18 years were excluded from our study due to the difficulty in interpretating the functional status. The mean duration of symptoms during the initial presentation was 2 years. RESULTS: The patients were followed-up at regular intervals, i.e., every month during the first 3 months and thereafter every 3 months during the first year. The minimum follow up period was 6 months and the maximum follow up was 28 months. The mean follow up in this study of 22 cases were 19 months. During followup, patients were assessed clinically for pain, spasm and neurological deficit. Radiological assessment of spinal fusion, percentage of slip, slip angle was done using serial X-rays and oblique views if necessary to look for the progression of listhesis. CONCLUSION: Defect repair using the pedicle screw and rod system is a technically simple and a safe procedure. It produces immediate fixation and minimize the risk of neurologic injury. The pedicle screw and rod system is easy to use and allow for anatomic restoration of the isthmus in isthmic spondylolisthesis or restoring the stability after laminectomy/discectomy in degenerative spondylolisthesis. No material failure was noted with a mean follow up of 27 months. Patients showed good clinical outcome and significant pain reduction in 86.36%. Restoration for a pain limited comfortable daily life was achieved early. In few patients work or demanding house hold activities was also obtained. In a mean follow up 27 months, no signs of adjacent disc degeneration was noted clinically. However, the disc degenerative changes can be documented only by MRI or Discography.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Situ Posterior Spinal Fusion ; Pedicle Screws and Rods ; Grade I and Grade II Isthmic ; Degenerative Spondylolisthesis.
Subjects: MEDICAL > Orthopaedics
Depositing User: Subramani R
Date Deposited: 14 Sep 2017 02:52
Last Modified: 14 Sep 2017 02:52

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