Sagittal reconstruction of lumbosacral contiguous double-level spondylolytic spondylolisthesis: a comparison of double-level and single-level transforaminal lumbar interbody fusion
Abstract Background Contiguous double-level lumbar spondylolytic spondylolisthesis is an extremely rare condition. There is a paucity of data of lumbosacral deformity and sagittal spino-pelvic malalignment among these patients. Moreover, the effect of transforaminal lumbar interbody fusion (TLIF) on...
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| Format: | Article |
| Language: | English |
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BMC
2019-05-01
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| Series: | Journal of Orthopaedic Surgery and Research |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13018-019-1197-7 |
| _version_ | 1811187042628927488 |
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| author | Chang-zhi Du Song Li Liang Xu Qing-shuang Zhou Ze-zhang Zhu Xu Sun Yong Qiu |
| author_facet | Chang-zhi Du Song Li Liang Xu Qing-shuang Zhou Ze-zhang Zhu Xu Sun Yong Qiu |
| author_sort | Chang-zhi Du |
| collection | DOAJ |
| description | Abstract Background Contiguous double-level lumbar spondylolytic spondylolisthesis is an extremely rare condition. There is a paucity of data of lumbosacral deformity and sagittal spino-pelvic malalignment among these patients. Moreover, the effect of transforaminal lumbar interbody fusion (TLIF) on sagittal realignment still remains largely unknown. The aim of the study is to investigate the reconstruction of sagittal alignment and the improvement of clinical outcomes after posterior instrumented double-level or single-level TLIF. Methods From January 2010 to September 2018, the records of patients with contiguous L4/5 and L5/S1 double-level spondylolytic spondylolisthesis were retrospectively reviewed. Patients who had undergone double-level or single-level TLIF and a minimum of 2 years’ follow-up were included. The slippage parameters and spino-pelvic parameters were measured preoperatively, postoperatively, and at the latest follow-up. Results A total of 58 patients (21 males and 37 females, mean age of 57.1 ± 6.9 years) were enrolled. Thirty-eight patients were treated with double-level TLIF and the remaining 20 with single-level TLIF (L4/5 in 14; L5/S1 in 6). After surgery, the spondylolisthesis was significantly reduced at both L4/5 and L5/S1 level (all P < 0.001). There was a significant reduction in pelvic tilt (P < 0.001) and a significant increase in sacral slope (P < 0.001). Significant increase in L4–S1 height (P < 0.001) and L4–S1 lordosis (P = 0.012) and decrease in L5 slope (P = 0.004) and L5 incidence (P = 0.001) were also observed. Compared to single-level TLIF, double-level TLIF increased L4–S1 height (P < 0.001) and L4–S1 lordosis (P < 0.001) and reduced L4-SVA (P = 0.007) and L5 incidence (P = 0.013) more obviously, and the sagittal balance was better corrected in double-level TLIF group (P = 0.006). Double-level TLIF group showed larger increase in VAS scores for low back pain. The incidence of implant-related complications was lower in the double-level group. Conclusion Posterior short-segment instrumented TLIF can bring favorable radiographic and clinical outcomes in patients with lumbosacral contiguous double-level spondylolytic spondylolisthesis. Double-level TLIF is more efficient to improve L4–S1 height, regional lumbar lordosis, and global sagittal balance. |
| first_indexed | 2024-04-11T13:56:30Z |
| format | Article |
| id | doaj.art-e9f3d5e32ec84a3ebd1a29f2ffb8f267 |
| institution | Directory Open Access Journal |
| issn | 1749-799X |
| language | English |
| last_indexed | 2024-04-11T13:56:30Z |
| publishDate | 2019-05-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Orthopaedic Surgery and Research |
| spelling | doaj.art-e9f3d5e32ec84a3ebd1a29f2ffb8f2672022-12-22T04:20:20ZengBMCJournal of Orthopaedic Surgery and Research1749-799X2019-05-0114111010.1186/s13018-019-1197-7Sagittal reconstruction of lumbosacral contiguous double-level spondylolytic spondylolisthesis: a comparison of double-level and single-level transforaminal lumbar interbody fusionChang-zhi Du0Song Li1Liang Xu2Qing-shuang Zhou3Ze-zhang Zhu4Xu Sun5Yong Qiu6Department of Spine Surgery, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical UniversityDepartment of Spine Surgery, Nanjing Drum Tower Hospital, Medical School of Nanjing UniversityDepartment of Spine Surgery, Nanjing Drum Tower Hospital, Medical School of Nanjing UniversityDepartment of Spine Surgery, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical UniversityDepartment of Spine Surgery, Nanjing Drum Tower Hospital, Medical School of Nanjing UniversityDepartment of Spine Surgery, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical UniversityDepartment of Spine Surgery, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical UniversityAbstract Background Contiguous double-level lumbar spondylolytic spondylolisthesis is an extremely rare condition. There is a paucity of data of lumbosacral deformity and sagittal spino-pelvic malalignment among these patients. Moreover, the effect of transforaminal lumbar interbody fusion (TLIF) on sagittal realignment still remains largely unknown. The aim of the study is to investigate the reconstruction of sagittal alignment and the improvement of clinical outcomes after posterior instrumented double-level or single-level TLIF. Methods From January 2010 to September 2018, the records of patients with contiguous L4/5 and L5/S1 double-level spondylolytic spondylolisthesis were retrospectively reviewed. Patients who had undergone double-level or single-level TLIF and a minimum of 2 years’ follow-up were included. The slippage parameters and spino-pelvic parameters were measured preoperatively, postoperatively, and at the latest follow-up. Results A total of 58 patients (21 males and 37 females, mean age of 57.1 ± 6.9 years) were enrolled. Thirty-eight patients were treated with double-level TLIF and the remaining 20 with single-level TLIF (L4/5 in 14; L5/S1 in 6). After surgery, the spondylolisthesis was significantly reduced at both L4/5 and L5/S1 level (all P < 0.001). There was a significant reduction in pelvic tilt (P < 0.001) and a significant increase in sacral slope (P < 0.001). Significant increase in L4–S1 height (P < 0.001) and L4–S1 lordosis (P = 0.012) and decrease in L5 slope (P = 0.004) and L5 incidence (P = 0.001) were also observed. Compared to single-level TLIF, double-level TLIF increased L4–S1 height (P < 0.001) and L4–S1 lordosis (P < 0.001) and reduced L4-SVA (P = 0.007) and L5 incidence (P = 0.013) more obviously, and the sagittal balance was better corrected in double-level TLIF group (P = 0.006). Double-level TLIF group showed larger increase in VAS scores for low back pain. The incidence of implant-related complications was lower in the double-level group. Conclusion Posterior short-segment instrumented TLIF can bring favorable radiographic and clinical outcomes in patients with lumbosacral contiguous double-level spondylolytic spondylolisthesis. Double-level TLIF is more efficient to improve L4–S1 height, regional lumbar lordosis, and global sagittal balance.http://link.springer.com/article/10.1186/s13018-019-1197-7Double-level spondylolysisIsthmic spondylolisthesisSpino-pelvic parametersTransforaminal lumbar interbody fusion |
| spellingShingle | Chang-zhi Du Song Li Liang Xu Qing-shuang Zhou Ze-zhang Zhu Xu Sun Yong Qiu Sagittal reconstruction of lumbosacral contiguous double-level spondylolytic spondylolisthesis: a comparison of double-level and single-level transforaminal lumbar interbody fusion Journal of Orthopaedic Surgery and Research Double-level spondylolysis Isthmic spondylolisthesis Spino-pelvic parameters Transforaminal lumbar interbody fusion |
| title | Sagittal reconstruction of lumbosacral contiguous double-level spondylolytic spondylolisthesis: a comparison of double-level and single-level transforaminal lumbar interbody fusion |
| title_full | Sagittal reconstruction of lumbosacral contiguous double-level spondylolytic spondylolisthesis: a comparison of double-level and single-level transforaminal lumbar interbody fusion |
| title_fullStr | Sagittal reconstruction of lumbosacral contiguous double-level spondylolytic spondylolisthesis: a comparison of double-level and single-level transforaminal lumbar interbody fusion |
| title_full_unstemmed | Sagittal reconstruction of lumbosacral contiguous double-level spondylolytic spondylolisthesis: a comparison of double-level and single-level transforaminal lumbar interbody fusion |
| title_short | Sagittal reconstruction of lumbosacral contiguous double-level spondylolytic spondylolisthesis: a comparison of double-level and single-level transforaminal lumbar interbody fusion |
| title_sort | sagittal reconstruction of lumbosacral contiguous double level spondylolytic spondylolisthesis a comparison of double level and single level transforaminal lumbar interbody fusion |
| topic | Double-level spondylolysis Isthmic spondylolisthesis Spino-pelvic parameters Transforaminal lumbar interbody fusion |
| url | http://link.springer.com/article/10.1186/s13018-019-1197-7 |
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