The Application Of The Spinal And Pelvic Parameters In The Treatment Of Degenerative Lumbar Spondylolisthesis

Objectives: 1.Compare the effect of the reduction of spondylolisthesis during the surgical treatment of degenerative lumbar spondylolisthesis on the postoperative therapeutic effect;2.compare the effect of the reduction or non reduction of spondylolisthesis during the surgical treatment of degenerative lumbar spondylolisthesis on the postoperative spinal and pelvic parameters;3.compare the difference between the postoperative spinal and pelvic parameters and the normal national reference values.Methods: 1.The thesis studies 36 patients with degenerative lumbar spondylolisthesis who had PLIF surgical treatment in the Department of orthopedics in the General Hospital of Ningxia Medical University from January 2015 to January 2018.According to Meyerding,there were 28 cases in grade I and 8 cases in grade Ⅱ,among which,21 cases were in L4 and15 cases in L5.These patients were composed of 9 males and 27 females with an average age of 59.86±7.57.The average time of the last follow-up time was 17.9±3.72 months.All the 36 patients took the spinal X-rays before the operation.The preoperative JOA low back pain and ODI dysfunction score were completed as well.They are all treated by the classical PLIF.According to the immediate postoperative X-rays,these patients were divided into reduction group and non reduction group.Among them,24 cases had restored and 12 had not.All the patients were recovered when they discharged from the hospital,and there was no history of spinal surgery during the follow-up time.The spinal X-rays were took again in the last follow-up time,JOA and ODI were also evaluated for another time.The Pelvic Incidence(PI),Pelvic Tilt(PT),Sacral Slope(SS);lumbar lordosis(LL),thoracic kyphosis(TK),pelvic angle(PA),Lumbar Lordosis(LL),Thoracic Kyphosis(TK),Pelvic Angle(PA),LumbopelvicLordosis(PR-LI-PR-L5),Total Lumbopelvic Lordosis(PR-T12),Sagittal Vertical Axis(SVA),L4 Slope(L4S)and L5 Slope(L5S)were respectively measured on the preoperative X-ray films and the X-ray films in the last follow-up time.Then,compare the difference between the preoperative and postoperative parameters of the spines and pelvises.2.The correlation analysis was conducted between the preoperative and postoperative JOA and ODI score.In addition,the differences between preoperative and postoperative reduction and non reduction were also compared.3.Compare the difference between the two groups of the spinal and pelvic parameters measured in the last follow-up time,and respectively conduct correlation analysis with normal national reference values by using two-independent-samples t-test.Results: 1.No matter whether the spondylolisthetic vertebras would be restored during the surgery,the pain and limb dysfunction of the patients with degenerative lumbar spondylolisthesis were significantly alleviated after the surgical treatment(PLIF).The differences between the preoperative and the final JOA pain score,surgical alleviation on the pain and ODI dysfunction score were statistically significant(P < 0.05).2.Compared with the preoperative PT values,the PT values of the reduction and non reduction groups were decreased in the last follow-up time,and the difference was statistically significant for the reduction group(p < 0.05).There was no significant difference between the two groups in the PI values(P > 0.05).The values of SS and LL increased in the last follow-up time,and the difference of the values of SS was statistically significant for the reduction group(p < 0.05),nevertheless,the difference of the values of LL was statistically significant for both groups(p< 0.05).The preoperative and the last follow-up values of PA and SVA were significantly different for both groups(p < 0.05).3.There was significant difference between the last follow-up values of PT,PI,LL,TK and PA of the two groups and the normal national reference values.There was no significant difference between the last follow-up values of SVA and SS and those normal national reference values in non reduction group(P > 0.05),while there was a significant difference in reduction group(P < 0.05).Conclusion: 1.The patients with DLS had a good therapeutic effect after the surgical treatment---PLIF,no matter whether the spondylolisthesis was completely restored during the surgery.2.After the surgical---PLIF,there were some changes in the pertinent spinal and pelvic parameters,among which the changes in PT,SS and LL had certain reference value for the surgical plan.3.The pertinent spinal and pelvic parameters of the patients with DLS were unable to reach the normal national reference level after the surgical---PLIF,regardless of whether they were completely restored during the surgery.