No correlation between slip reduction in low-grade spondylolisthesis or change in neuroforaminal morphology and clinical outcome

Hagenmaier, HS Femke; Delawi, Diyar; Verschoor, Nico; Oner, F. Cumhur; Susante, Job Lc van

doi:10.1186/1471-2474-14-245

Cited by 23 publications

(24 citation statements)

References 32 publications

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“…In a prospective study [15], pedicle screws were pulled out intraoperatively in two elderly patients (5.6%) using traditional reduction method and the complication rate was 22.2%. Another study reported a correction rate of 30.1% and a fusion rate of 64% on CT-scan for patients with low-grade spondylolisthesis after 1 year's follow-up [22]. Okuda et al reported a complication rate of 16% and a correction rate of 58.3% in elderly patients with a nonunion rate of 4% [37].…”

Section: Discussionmentioning

confidence: 98%

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A new lever reduction technique for the surgical treatment of elderly patients with lumbar degenerative Spondylolisthesis

Kong

Wang

et al. 2020

BMC Musculoskelet Disord

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Background: Proper reduction method for Lumbar degenerative spondylolisthesis (LDS) is still controversial. The aim of this study was to determine the safety and effectiveness of lever reduction combined with traditional elevating-pull reduction technique for the treatment of elderly patients with LDS. Methods: From May 2015 to December 2017, 142 elderly patients (≥65 years) diagnosed with LDS were enrolled in this study with a mean follow-up of 25.42 ± 8.31 months. All patients were operated using lever reduction combined with traditional elevating-pull reduction technique. Patient age, sex, body mass index, bone mineral density, preoperative comorbidities, surgical duration, blood loss, and surgical complications were collected form patient charts. Clinical data as visual analog scale (VAS), Oswestry Disability Index (ODI), and 36-Item Short Form Health Survey (SF-36) were collected preoperatively, 1 month postoperatively, and at the final follow-up. Radiographic evaluation included slip percentage, slip angle (SA), lumbar lordosis (LL), and fusion status. Results: The clinical parameters of VAS back , VAS leg , ODI, and SF-36 had significantly improved at both followups after surgery. A significant improvement was indicated for slippage reduction at both follow-ups, showing no significant correction loss after surgery. SA significantly increased after surgery and was well maintained at the final follow-up. LL was not affected by the surgery. At the final follow-up, complete fusion was obtained in 121 patients (85.2%) and partial fusion in 21 (14.8%). Revision surgery was performed for one patient. Screw loosening was observed in 3 (2.11%) cases. No nerve root injury or adjacent segment disease was observed. Conclusions: This new lever reduction combined with traditional elevating-pull reduction technique for the surgical treatment of elderly patients with LDS is both safe and effective. Satisfactory correction and fusion rates were achieved with acceptable correction loss and reduction-related complications.

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Section: Discussionmentioning

confidence: 98%

“…Fusion was assessed on post-operative computed tomographic images obtained at the final follow-up according to the classification of Tan et al [21] (Table 1). Pedicle screw loosening was viewed as any pedicular cortical breach or directional change [22].…”

Section: Radiological Assessmentmentioning

confidence: 99%

A new lever reduction technique for the surgical treatment of elderly patients with lumbar degenerative Spondylolisthesis

Kong

Wang

et al. 2020

BMC Musculoskelet Disord

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“…Reduction of the listhesis is commonly advocated but the relationship between reduction itself andimprovement of clinical outcome has only recently attracted clinical interest [ 2 7 20 ]. Comparison of PLIF with reduction versus in-situ fusion in low grade spondylolisthesis showed no influence of reduction on clinical outcome [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

“…All radiographic parameters were measured on the preoperative and postoperative lateral radiographs, and changes were recorded ( Fig. 2 ) [ 20 ]. All measurements were performed and repeated by two blinded observers (A.C. and U.K.D.)…”

Section: Methodsmentioning

confidence: 99%

Interbody Fusion in Low Grade Lumbar Spondylolsithesis: Clinical Outcome Does Not Correalte with Slip Reduction and Neural Foraminal Dimension

et al. 2016

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Study DesignProspective nonrandomized study.PurposeTo find a possible correlation between clinical outcome and extent of lumbar spondylolisthesis reduction.Overview of LiteratureThere is no consensus in the literature concerning whether a beneficial effect of reduction on outcome can be expected following reduction and surgical fusion for low grade lumbar spondylolisthesis.MethodsForty six patients with a mean age of 37.5 years (age, 17–48 years) with isthmic spondylolisthesis underwent interbody fusion with cages with posterior instrumentation (TLIF). Clinical outcome was measured using visual analogue score (VAS) and Oswestry disability index (ODI). Foraminal dimensions and disc heights were measured in standard digital radiographs. These were analyzed at baseline and 1 year after surgery and changes were compared. Radiographic fusion was judged with computed tomography scans at 1 year.ResultsNinety percent of the patients had good or very good clinical results with fusion and instrumentation. Baseline and one-year postoperative mean VAS score was 6.33 (range, 5–8) and 0.76 (range, 0–3), respectively (p=0.004). Baseline and one-year postoperative, mean ODI score was 48 (range, 32–62) and 10 (range, 6–16), respectively (p<0.001). A mean spondylolisthesis slip of 32.1% was reduced to 6.7% at 1 year. Average anterior disc height, posterior disc height, vertical foraminal dimension), and foraminal) diameter improved from 9.8 to 11.7 mm (p=0.005), 4.5 to 5.8 mm (p=0.004), 11.3 to 12.6 mm (p=0.002), and 18.6 to 20.0 mm (p<0.001), respectively. The fusion rate was 75% with TLIF. There is no significant correlation between the improvements of ODI scores and the extent of slip reduction.ConclusionsNeural decompression and interbody fusion can significantly improve pain and disability but the clinical outcome does not correlate with radiological improvement in the neural foraminal dimension.

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“…These results are in accordance with repositioning results achieved via traditional techniques, for example, Wegmann et al [24], who described a similar percentage of postoperative reduction of slippage in their series of 40 patients undergoing standard PLIF; 34.2% (SD 14.7) preoperatively to 15.1% (SD 8.3) postoperatively). Nonetheless, it must be noted that although intellectually appealing, the correlation of realignment with clinical outcome remains controversial, especially for low grade spondylolisthesis [24,25].…”

Section: Clinical and Radiological Outcomementioning

confidence: 98%

A novel minimally invasive technique for lumbar decompression, realignment, and navigated interbody fusion

Reinshagen

Rueß

Walcott

et al. 2015

Journal of Clinical Neuroscience

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No correlation between slip reduction in low-grade spondylolisthesis or change in neuroforaminal morphology and clinical outcome

Cited by 23 publications

References 32 publications

A new lever reduction technique for the surgical treatment of elderly patients with lumbar degenerative Spondylolisthesis

A new lever reduction technique for the surgical treatment of elderly patients with lumbar degenerative Spondylolisthesis

Interbody Fusion in Low Grade Lumbar Spondylolsithesis: Clinical Outcome Does Not Correalte with Slip Reduction and Neural Foraminal Dimension

A novel minimally invasive technique for lumbar decompression, realignment, and navigated interbody fusion

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