The CT, MRI Characteristics Of Degenerative Spondylolisthesis And Isthmic Spondylolisthesis, And Its Impact On MIS-TLIF

Objective: To evaluate the value of CT and MRI in the diagnosis ofthe degenerative spondylolisthesis and isthmic spondylolisthesis, and toinvestigate the clinical effects of minimally invasive transforaminallumbar interbody fusion (MIS-TLIF) for the treatment of the degenerativespondylolisthesis and isthmic spondylolisthesis.Methods:A total of84cases of lumbar spondylolisthesis withdetailed CT and MRI data treated with MIS-TLIF in our hospital fromSeptember2012to January2014were retrospectively analyzed. Therewere36patients with isthmic spondylolisthesis (included20males and16females, the age was from34to75years with an average of54years.)and48patients with degenerative spondylolisthesis (included21malesand27females, the age was from45to86years with an average of65years.). Data concerning blood loss, operative time, postoperativeneurologic symptoms, the effect of reset, the improvement of osphyalgiasymptoms, the bone graft fusion time, Oswestry disability index (ODI)score were analyzed statistically.Results:34cases with degenerative spondylolisthesis occurred in L4,accounting for70.8%.26cases with isthmic spondylolisthesis occurred inL5, accounting for72.2%. The degree of the displacing vertebrae hadnotable difference between the degenerative spondylolisthesis andisthmic spondylolisthesis (P<0.05).The degenerative cases and degree ofthe lumbar intervertebral disc and intervertebral joint in the degenerative spondylolisthesis were more than those in the isthmicspondylolisthesis(P<0.01).All48cases with degenerativespondylolisthesis were characterized by superior line sign，36cases withisthmic spondylolisthesis were characterized by inferior line sign. Therewere no significant differences in the blood loss, operative time,postoperative neurologic symptoms, the bone graft fusion time, Oswestrydisability index (ODI) score between degenerative spondylolisthesisgroup and isthmic spondylolisthesis group. Although degenerativespondylolisthesis group on the effect of reset was better than isthmicspondylolisthesis group, quality of life in two groups of1year aftersurgery were obviously improved，without statistical significance.Conclusion:The degree of the lumbar intervertebral disc andintervertebral joint in the degenerative spondylolisthesis are more thanthose in the isthmic spondylolisthesis.The lumbar isthmic defect is adirect sign in diagnosis of the isthmic spondylolisthesis. The superior linesign and inferior line sign are the reliable and indirect signs todifferentiate degenerative spondylolisthesis and isthmic spondylolisthesis.CT and MRI have advantages to make differential diagnosis ofdegenerative spondylolisthesis and isthmic spondylolisthesis. Aftertreatment with MIS-TLIF, postoperative neurologic symptoms andquality of life in two groups of1year after surgery are obviouslyimproved. It provides a new choice for the indications of MIS-TLIF.