The clinical features and posterior operation for traumatic lumbar spondylolisthesis

English Keywords:Trauma  Lumbar spondylolisthesis  Internal fixation  Interbody fusion

English Abstract:

  【Abstract】 Objectives: To explore the clinical characteristics and preliminary outcome of posterior operation for traumatic lumbar spondylolisthesis. Methods: Between August 2009 and June 2013, 9 patients(5 males and 4 females; average age: 36.5±16.3 years, range: 21 to 60 years) with traumatic lumbar spondylolisthesis undergoing surgeries were retrospectively reviewed. The mechanism of injury included heavy blow injury in 3 cases, high fall injury in 4 cases, and traffic accident injury in 2 cases. According to Frankel neurological function grade system, 1 patient was rated as grade E, 4 as grade D, 3 as grade C before operation; the affected segment included L4 in 3 patients and L5 in 6 patients based on X-ray films before operation. According to Meyerding spondylolisthesis grading, 2 cases were classified as degree Ⅰ, 4 as degree Ⅱ, 2 as degree Ⅲ, and 1 as degree Ⅳ. The reduction of spondylolisthesis and bone graft fusion were assessed on X-ray films and three-dimensional CT scans during follow-up. The clinical outcomes were evaluated by visual analogue scale(VAS) and Oswestry disability index(ODI) scores. Results: All patients had a follow-up of 12-58 months(average: 35.0±11.6 months). At 2 weeks after operation and last follow-up, VAS scores(2.6±0.6, 2.1±0.4) and ODI scores(16.2±2.5, 15.3±2.1) significantly improved compared with the preoperative ones(7.3±1.2, 69.7±12.3)(P<0.05); however, no significant difference was found between 2 weeks after operation and last follow-up (P>0.05). The reontgenograph showed good position of the instrument after operation. The fusion rate was 100% based on three-dimensional CT scans, and the fusion time was 6-12 months. At the last follow-up, the spondylolisthesis was degree 0 in 6 cases, degree Ⅰ in 2 cases and degree Ⅱ in 1 case according to Meyerding grading; the Frankel neurological function was grade E in 6 cases, grade D in 3 cases, and grade C in 1 case. Conclusions: Acute traumatic lumbar spondylolisthesis is always caused by severe trauma and mostly occurred at L5, L4 level, and combined with ligament and joint capsule injury, facet fracture. Posterior transpedicular screw system and interbody fusion can get satisfactory radiological and clinical outcome.