The Addition Of Posterolateral Lumbar Fusion And Posterior Lumbar Interbody Fusion Using Cage To Pedicle Screw Fixation In The Treatment Of Lumber Spondylolisthesis

Spondylolisthesis is one of the most important factors that result in low back pain . The etiology and pathogenesis of Spondylolisthesis is varied. The optimal procedure for the treatment of Spondylolisthesis remains controversial. The purpose of this study was to evaluate the value of using posterolateral lumbar fusion and posterior lumbar interbody fusion with cage and pedicle screw fixation in the treatment of lumbar Spondylolisthesis. Methods From August 1997 to August 2003, 66 consecutive adult patients undergone surgical treatment were divided into two groups. Treatment group of 36 consecutive adult patients from May 1999 to August 2003 was treated with pedicle screw fixation and posterolateral lumbar fusion and posterior lumbar interbody fusion using cage. Control group of 30 consecutive adult patients from August 1997 to May 1999 was treated with pedicle screw fixation and posterolateral lumbar fusion. The follow-up study includes slipping percentage, slipping angle, heights of intervertebral space , relative intervertebral space and foramen, fusion rate, screw broken rate and clinical outcomes. Results Treatment group of 36 patients was followed up for an average of 24 months (range 6-48 months )after operation. Significant changment was found comparision of pre- andpost- operative slipping percentage, slipping angle, heights of significant intervertcbral space, relative intervertebral space and foramen. Heights of relative intervertcbral space, intervertebral space and foramen increased, slipping angle and slipping percentage decreased. Significant improvement of JOA score was observed . During the period of follow-up, recurrence of deformity was found. Comparing with control group, treatment group obtained significant change of post-operative and follow-up slipping percentage, slipping angle, heights of intervertebral space, relative intervertebral space and foramen . Meanwhile treatment group obtained significant decrease of dormity of follow-up reduction rate, heights of inlcrvertcbral space , relative intervertebral space and foramen. Treatment group obtained significant improvement of fusion rate> of JOA score and significant decrease of screw broken rate. Conclussion Fusion after decompression is critical. Complete decompression and reduction as much as possible and advanced ,reliable internal fixation are basic in the treatment of Spondylolisthesis . Improvement of symptom, high fusion rate could be achieved by using posterolateral lumbar fusion and posterior lumbar interbody fusion with cage and pedicle screw fixation . It has the advantages of relieving symptom, increasing and keeping intervertcbral space, decreasing screw broken rate and improving fusion rate effectively. It is a clinically safe , reasonable and effective technique of PLIF to treat lumbar Spondylolislhesis .