Clinical Effect Analysis Of Degenerative Lumbar Spondylolisthesis After PLIF Of Different Segments

Objective All clinical data were followed up for more than one year to discuss the difference of clinical efficacy between L4 spondylolisthesis and L5 spondylolisthesis treated with single-stage PLIF.Methods 17 patients with degenerative lumbar spondylolisthesis diagnosed in Ning Xia Medical University General Hospitall from December 2015 to October 2017 were retrospectively analyzed,including 9 cases of L4 spondylolisthesis and 8 cases of L5 spondylolisthesis.All 17 patients underwent single-stage PLIF surgery.The age of surgery was 53.9 9.6 years old(35-72 years old).The average follow-up after surgery was 16.3 33.5 months(13-23 months).All the imaging data include: preoperative lumbar X-ray examination,lumbar CT,lumbar MRI and the last follow-up of the whole spine X-ray film at the anteroposterior and lateral positions;Pelvic incidence angle(PI),sacrum inclination angle(SS),pelvic inclination angle(PT),lumbar lordosis angle(LL),residual LL,C7-S1 SAV,etc.were measured using PACS system of Ning Xia Medical University General Hospital.Using X-ray films to jointly determine the postoperative curative effect.Taking the total spine X-ray measurement results and ODI scores of patients with L4 spondylolisthesis after PLIF as control,the total spine X-ray measurement results and ODI scores of patients with L5 spondylolisthesis after PLIF are compared.Firstly,the differences in clinical efficacy and spinal-pelvic sagittal balance between L4 spondylolisthesis and L5 spondylolisthesis after PLIF are analyzed,and then the influence of spinal-pelvic sagittal balance on surgical efficacy is analyzed.Results the residual LL,C7-S1 SAV and postoperative efficacy(ODI index)in the last follow-up of L4 spondylolisthesis group were significantly different from those in L5 spondylolisthesis group(|Z|>1.96,P<0.05).The PI,SS,PT,LL of the experimental group and the control group had no significant difference(|Z|<1.96,P>0.05).Conclusion(1)Excessive small residual LL and excessive C7-S1 SAV after PLIF for degenerative lumbar spondylolisthesis patients will affect the clinical efficacy,aggravate the load of adjacent segments,and become an important inducement to induce adjacent vertebral diseases;(2)The anatomical structure of L5 vertebral body is special,so we should be more careful when fusing L5-S1 segments.