Spondilolysthesis L5-S1: An Original Article

Special Article: Laminectomy

Austin J Surg. 2023; 10(3): 1307.

Spondilolysthesis L5-S1: An Original Article

Saccomanni Bernardino, MD*

Department of Orthopaedic and Trauma Surgery, Asl Bari, Italy

*Corresponding author: Saccomanni Bernardino Department of Orthopaedic and Trauma Surgery, Asl Bari, Viale Regina Margherita, 70022, Altamura (Bari), Italy. Tel: 3208007854 Email: bernasacco@yahoo.it

Received: May 12, 2023 Accepted: June 23, 2023 Published: June 30, 2023

Abstract

Objectives: To assess the clinical, functional and radiological outcome of Posterior Lumbar Interbody Fusion (PLIF) by Banana cage with bone graft.

Material and Methods: This retrospective analytical study was carried out in unit of Orthopaedic surgery department from January 2010 to December 2020. We did PLIF by Banana cage with bone graft for High-grade Lumbar Spondylolisthesis at L5-S1. The follow up period ranges from 1 year to 2 years (average 18 months). Within these follow up period we have assessed the patients clinically, functionally and radiologically. All patients were assessed by Visual Analogue Score (VAS), Oswestry Disability Index (ODI), Waddell Disability Index (WDI), Spino-pelvic parameters, Modified Macnab’s Criteria to find out overall outcome and Hackenberge ctriteria for radiological fusion.

Results and Conclusions: Total 40 patients were included among them 16were male and 24 were female. The average age of the patients was 52.45±10.1 years. Maximum (60.0%) patients were housewife followed by 20.0%, 10.0%, 10% were day laborer, farmer and service holder respectively. Average pelvic tilt was 26.05±6.27° preoperatively and 24.10±6.26° at the final follow-up, average PI was 66.07±7.39° preoperatively and 61.19±7.08° at the final follow-up. Preoperative lumbar lordosis was 45.55±6.71° with postoperatively 37.29±6.19°at final follow-up. VAS score and ODI scales were improved significantly from preoperative 6.90±6.16 and 57.60±15.66, respectively, to postoperatively and final follow-up 2.0±0.8 and 7.60±2.40, respectively. Pre-operative Translation ratio, slip angle and disc height ratio were 21.96±10.25, -18.87±8.28, 11.03±4.36 respectively and postoperatively 13.17±6.57, -18.44±7.12, 19.60±3.36 respectively. Fusion was achieved in 36 cases (90%), 3 cases (7.5%) were fragmented and pseudoarthrosis showed only 1 case (2.5%). Most of the study population according to post operative clinical outcome showed excellent outcome (95%), 1 (2.5%) case had good and 1 (2.5%) case had fair outcome.

Conclusion: It can be concluded that, Posterior Lumbar Interbody Fusion (PLIF) by Banana cage with bone graft can be a very good option for the treatment of High-grade Lumbar Spondylolisthesis at L5-S1 levels.

Keywords: Spondylolisthesis; Banana cage; Patients

Introduction

Pain in the lower lumbar region is a socioeconomically serious medical illness worldwide. The main reason from physiological consideration is micro and macro instability of spine [1,2]. There are numerous causes for backache. Spondylolisthesis is one among them [3]. Spondylolisthesis is defined as a displacement of one vertebra over the next lower vertebra in the sagittal plane. High-Gradespondylolisthesis (HGS) is defined as greater than 50% slippage of a spinal vertebral body relative to an adjacent vertebral body AS per Meyerding classification, and most common location being down. Relationship of PT and SS is affected by lumbosacropelvic L5/S1 followed by L4/L5 [4]. Most commonly used classification flexion and extension. VRL, Vertical reference line. (From Jackson R, Kanemura T, Kawakami N, Hales C: Lumbopelvic lordosis and systems for spondylolisthesis were introduced by Wiltse et al and Marchetti and Bartolozzi which is most practical classification pelvic balance on repeated standing lateral radiographs of adult system in terms of prognosis and therapy [5,6].

In addition to the bony morphologic changes seen in high-dysplastic spondylolisthesis, spinopelvic balance plays an Oswestry Disability index important role in the development and progression of spondylolisthesis [7]. Altered biomechanical stresses found due to abnormal spino-pelvic balance at the lumbosacral junction and compensatory mechanisms used to maintain adequate posture and gait.

Degenerative Lumbar Spondylolisthesis (DLS) is always associated with facet joint degeneration and mostly observed in persons over the age of 50 years. Individuals may suffer from spinal stenosis with back and leg pain [8]. Decompression with fusion better than isolated decompression because it will further destabilize the spine, permitting further slip progression [9,10].

Vertebral Interbody Fusion (IBF), is relatively new set of technique, has become very popular in the treatment of symptomatic DLS. Interbody fusion provides a number of potential benefits forreliving symptoms. It improves the biomechanical stability of a construct mainly by stabilizing the anterior column. This can be proved important especially in patients with High-grade spondylolisthesis, Unstable slips, Degenerative type of scoliosis, and retained disc height) [11-14]. Insertion of interbody devices also improve sagittal alignment and restore disc and foraminal height as well, which ultimately provide indirect decompression of foraminal and canal stenosis and aiding in spondylolisthesis reduction [12,15].

Material and Methods

Posterior Lumbar Interbody Fusion (PLIF) surgery is performed by the standard posterior approach. Wide laminectomy is done first followed by partial bilateral facetectomy, and then the neural elements are retracted to either side, to make space for disc space preparation and finally insertion of a titanium interbody. This retrospective analytical study included 40 patients were device packed with autogenous bone graft within the inter-carried out in unit of Orthopaedic surgery department vertebral space [16,17] from January 2010 to December 2020 (Figure 1). PLIF by Banana cage with bone graft was done for High-grade Lumbar Spondylolisthesis only at L5-S1. The follow up period ranges from 1 year to 2 years (average 18 months). Within these follow up period we have assessed the patients clinically, functionally and radiologically. All patients were assessed pre and post operatively by Visual Analogue Score (VAS), Oswestry Disability Index (ODI), Waddell Disability Index (WDI), Spino-pelvic parameters, Modified Macnab’s Criteria to find out overall outcome and Hackenberge ctriteria for radiological fusion. IBM-SPSS V26 software was used for statistical analysis.