Tactics of surgical treatment of spondylolisthesis

Abstract

The results of surgical treatment of 133 patients with spondylolisthesis are analysed. In 60 patients I—II degree, in 69 — III—IV degree, in 4 patients V degree (spondyloptosis) was diagnosed. Preoperative management included traditional and functional roentgenography of lumbosacral spine, myelography, CT and MRT. Tactics of surgical treatment depended on the degree of spondylolisthesis and clinical-roentgenologic manifestations of the disease. In 32 patients bone plasty was performed (posterior and anterior spondylodesis) without additional metal fixation, in 101 patients bone plastic operations were combined with the metal fixation of the lumbosacral spine. Various types of fixatives were used: external fixation device by Byzov (6 cases), Wilson plates (23), Kazmin distractors (20) and different types of transpedicular constructions (52). Vertebral canal revision was performed only in case of persistent neurologic symptomatology. In patients with III-IV degree of spondylolisthesis either interlaminectomy or laminectomy (in marked spondylolisthesis) was performed under the visual control of the dural sac and roots at the moment of reduction. In cases of high degree of dislocation the surgical treatment was performed in two steps — posterior metal fixation was supplemented with the anterior spondylodesis. It is concluded that transpedicular fixation in combination with bone plasty is the method of choice for the surgical treatment of spondylolisthesis. In Ш-IV degree of spondylolisthesis transpedicular fixation is to be combined with the anterior spondylodesis.

Keywords

spondylolisthesis / osteoplastic fixation / metal fixation

References

[1] Глазырин М.И. Клинико-биомеханические обоснования и оценка эффективности переднего спондилодеза с редукцией и без редукции позвонков при спондилолистезе: Дис. ... д-ра мед. наук. — М., 1981.

[2] Корж А.А., Хвисюк Н.И. //Ортопед, травматол. — 1972. — N 6. — С. 21-25.

[3] Митбрейт И.М. Спондилолистез. — М., 1978.

[4] Церлюк Б.М., Маркавс А.К. //Конф, травматологов- ортопедов ЛитССР совместно с Науч, об-вом травматологов-ортопедов ЛатвССР: Тезисы докладов. — Вильнюс, 1977. — С. 113-114.

[5] Ani N., Keppler L., Biscup R.S., Stef fee A.D. //Spine. — 1991. — Vol. 16. — P. 302-310.

[6] Boyd L.M., Ested B. Int. meetings on advanced spine teniques, 2nd. — Curacao, 1995.

[7] Dick W.T., Schnebel B. //Clin. Orthop. — 1988. — N 232. — P. 70-79.

[8] Dickman C.A. //BNI Q. — 1997. — Vol. 13. — P. 4-25.

[9] Dickman C.A., Sonntag V.K., Russell J.S. //Ibid. —1997. — Vol. 13. — P. 26-36.

[10] Edwards C.C., Bradford D.S. //Spine. — 1994. — Vol. 19. — P. 1535-1537.

[11] Daniele A. //Ibid. —1996. — Vol. 21. — P. 728-733.

[12] Freeman B.L., Donati N.L. //J. Bone Jt Surg. — 1989. — Vol. 71A, N 4. — P. 594-598.

[13] Gaines R.W., Nichols W.K. //Spine. — 1985. — Vol. 10. — P. 680-685.

[14] Hirabayashi S., Kumano K., Kuruoki T. //Ibid. —1990. — Vol. 15. — P. 1204.

[15] Hu S., David S. //Ibid. —1996. — Vol. 21. — P. 367-371.

[16] Kahanovitz N., Bullough P., Jacobs R.R. //Clin. Orthop. — 1984. —N 189. — P. 204-208.

[17] McAfee P.C. // J. Bone Jt Surg. -— 1999. — Vol. 81A, N 6. — P. 859-880.

[18] Parisini P., Silvestre M. Di, Greggi T. et al. // Chir. Organi Mov. — 2001 —Vol. 86. — P. 127-142.

[19] Roca J., Ubierna M.T., Caceres E. et al. //Spine. — 1999. — Vol. 24. — P. 709-715.

[20] Schwab F.J., Jean-Pierre C. //Ibid. —1997. — Vol. 22. — P. 1661-1667.

[21] Shirado O., Zdeblick T.A., McAfee P.C., Warden K.E. //J. Bone Jt Surg. — 1991. — Vol. 73A, N 4. — P. 518-526.

[22] Smith J.A. //Spine. —2001. — Vol. 26. — P. 2227-2234.

[23] Stef fee A.D., Biscup R.S., Stikowski D.J. //Clin. Orthop. — 1986. — N 203. — P. 45-53.

[24] Stef fee A.D., Stikowski D.J. //Ibid. —1988. — N 227. — P. 82-89.

[25] Zhao J., Yong Hai. //Spine. — 2000. — Vol. 25. — P. 425-430

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