Clinical comparement of two surgical protocols between pedicle screw reduction and intervertebral space distraction reduction in treating isthmic spondylolisthesis

English Keywords:Lumbar spondylolisthesis  Reduction  Spinal fusion

English Abstract:

  【Abstract】 Objective：To investigate the clinical effects of two surgical protocols between pedicle screw reduction and intervertebral space distraction reduction in treating isthmic spondylolisthesis.Method：68 cases with isthmic spondylolisthesis undergoing surgical treatment at two separate centers were reviewed retrospectively.Group A，32 cases，there were 5 at L4 and 27 at L5.Average preoperative slippage and JOA score were 35.8％±10.4％ and 17.2±1.6 respectively.After posterior lamenectomy and insertion of pedicle screws into involved level，reduction was accomplished by distraction and pulling of the reduction screws，after that，the disc space was prepared，finally the placement of cage and sliced autograft was performed sequently.Group B，36 cases，there were 6 at L4 and 30 at L5.Average preoperative slippage and JOA score were 36.1％±11.2％ and 17.9±1.4 respectively.Posterior laminectomy and unilateral facetectomy on the symptomatic side followed by reduction through intervertebral disc space distraction was performed，then pedicle screw instrument and one single fusion with bone graft was applied.The clinical outcomes were compared between the two groups.Result：The complication rate was 18.8%（6/32） in group A and 11.1%（4/36） in group B，no significant difference was found between two groups（P>0.05）.The follow up time was 24-60 months（average，39 months）.In group A，the slippage degree was 3.4％±1.9％ at final follow-up with the reduction rate of 90.5%，fusion rate at two year follow-up of 96.9%，JOA score of 26.5±0.9 at final follow-up，clinical satisfaction rate of 87.5%.While in group B，the slippage degree was 10.3％±4.1％ at final follow-up with reduction rate of 71.5%，fusion rate at two year follow-up of 97.2%，the JOA score of 26.9±1.1 at final follow-up，clinical satisfaction rate of 86.1％.No significant difference was found in clinical satisfactory rate and fusion rate between two groups（P>0.05），however significant difference was noted in reduction rate between two groups（Ｐ<0.001）.Conclusion：The reduction rate by pedicle screw is superior to that by intervertebral disc space distraction，both two methods show efficacy in surgical treatment of lumbar spondylolisthesis.