OBJECTIVE: To summarize the efficacy of hemivertebral plate decompression, arch root internal fixation and bone graft fusion.
METHODS: Thirty-one patients with lumbar spondylolisthesis were treated with GSS-III internal fixation system after hemi-vertebral plate decompression and internal fixation, 30 cases were treated with autologous iliac bone graft fusion and 1 case was treated with intervertebral fusion device, and the treatment effect was observed. Results: 24 cases were completely repositioned, 7 cases were incompletely repositioned, the postoperative healing time was 6-12 months, and the X-ray showed satisfactory fusion after 12 months, and the symptoms of postoperative lumbar and leg pain were significantly improved. The efficacy was observed for 2 years and was stable. Conclusion: The efficacy of hemi-vertebral plate decompression endoprosthesis implant fusion in the treatment of lumbar spondylolisthesis is certain.
From 2002 to 2007, 33 cases of lumbar spondylolisthesis were treated surgically in our department, 31 cases were treated with GSS-III internal fixation system, 30 cases were treated with intervertebral bone graft fusion, and 1 case was treated with intervertebral fusion device.
1.Case data
There were 31 cases in this group, 11 men and 20 women, aged 30 to 69 years, with the shortest duration of 6 months and the longest duration of 15 years, including 6 cases of degree I, 14 cases of degree II, 8 cases of degree III and 3 cases of degree IV. There were 31 cases of lumbar, 410 cases of lumbar, 520 cases of lumbar, 6 cases of true slippage, and 25 cases of pseudo-degenerative slippage. All cases had low back pain, 13 cases of lower limb hypokinesis, 15 cases of hyposensitivity, and 4 cases of anal sphincter hypofunction.
2.Surgical method
Under general anesthesia, the patient was placed in the prone position, and the posterior median incision was made with a length of 12 cm, and the posterior superior iliac spine was cut into a matchstick-like bone block, and the spinous process was preserved. The pedicle nail was implanted through the base of the transverse process, and the slipped vertebral body was confirmed by C-type X-ray machine and placed with a lifting nail. 24 cases were completely repositioned and 7 cases were incompletely repositioned, and as much cortical bone as possible was added to the intervertebral space, and some bone cortex was removed from the lateral side of the vertebral plate and the back of the articular eminence, and the iliac bone strip was locally implanted, and one case was treated with an intervertebral fusion and bone implant. Negative pressure drainage was performed for 24 to 48 hours after surgery.
3. Results
There were 31 cases in this group, with follow-up from 12 months to 60 months, with an average of 24 months. The symptoms of lumbar and leg pain were clearly reduced after surgery, and there was no infection.
4. Discussion
The incidence of lumbar spondylolisthesis is reported to be 5% in adults at home and abroad, and its surgical treatment has a history of 60 years. The current indications for surgery for lumbar spondylolisthesis are.
1, persistent low back pain as well as lower extremity pain that is ineffective through conservative treatment.
2, slippage showing progressive aggravation.
3, slippage greater than 50%.
4. Progressive postural or gait abnormalities. The current surgical approach mostly advocates spinal canal decompression and fusion of slipped vertebrae to reconstruct the normal sequence and stability of the spine. With the advancement of surgical technology and the research on the biomechanics of lumbar slipped vertebrae, it has been found that the pedicle is the strongest part of the spine, and the screws entering the vertebral body through the pedicle on both sides can not only be firmly combined with the vertebrae, but also effectively control the vertebral body with three-dimensional fixation and orthopedic functions. The surgical method has developed from the original decompression of the vertebral plate and external fixation of bone graft fusion to the present decompression of the vertebral plate and internal fixation of the arch root with bone graft fusion. Since Harrington first used the short-stage pedicle nail fixation system, clinical practice has demonstrated the system’s good repositioning ability, with a 90.5% slip repositioning rate. Along with the rapid development of internal fixation materials, the stability of the intervertebral body after repositioning has been further enhanced, and laminar decompression and internal arch root fixation with bone graft fusion have become the common treatment methods for lumbar spondylolisthesis nowadays.
The main cause of lumbar spondylolisthesis is the increase of decompression stress between vertebral bodies and the deficiency of anterior and middle columns, and the small joint is the part with the greatest decompression stress, so theoretically, in addition to internal fixation of bone graft, it is biomechanically advantageous to preserve part of the small joint, perform half-plate decompression, and perform intertransverse and intervertebral bone graft and internal fixation of the arch root in all cases. In all cases, intertransverse and intervertebral bone grafting and internal fixation were performed.
The aggravation of postoperative nerve root symptoms due to incomplete decompression is a more common complication, which directly affects the treatment outcome.
Our preventive measures are.
(1) Open the contralateral half of the vertebral plate, remove the medial part of the superior articular process to enlarge the lateral saphenous fossa, and check that there is no bony compression of the nerve root.
(2) Maintain the intervertebral space as high as possible to protect the nerve roots from compression by repositioning.
(3) Confirm that the bone fragments in the spinal canal are completely removed to prevent compression of the nerve roots by the bone fragments. In order to reduce the recurrence rate of slippage, we performed intervertebral fusion in all cases to ensure stability after repositioning. There were no complications of worsening neurological symptoms or recurrence of lumbar spondylolisthesis in all cases.
In conclusion, clinical observation showed that hemi-laminotomy decompression, arch root internal fixation and bone graft fusion can achieve satisfactory results in the treatment of degenerative lumbar spondylolisthesis, and this procedure has the advantages of less trauma and fewer postoperative complications compared with total laminotomy decompression, and the clinical treatment results are satisfactory.