Comparison of Sagittal Plane Realignment and Reduction with Posterior Instrumentation in Developmental Low or High Dysplastic Spondylolisthesis.
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BACKGROUND CONTEXT: In situ fusion is the gold standard method of treatmentof spondylolisthesis. There is no study in the literature evaluating the effect of sagittalcontour realignment on clinical outcomes in comparison with the addition of anteriorslippage reduction.PURPOSE: The correction of sagittal plane vs. reduction with instrumentation in thepatients with low or high dysplastic spondylolisthesis.STUDY DESIGN/SETTING: A prospective randomized study in patients treated withthe same surgical team at the same center.PATIENT SAMPLE: 40 patients, 20 with low and 20 with high dysplasticspondylolisthesis (mean age: 33.1±10.6; average follow-up: 37.9±11.9 Mo.).OUTCOME MEASURES: The extent of displacement, lumbosacral angle values,lumbar sagittal contours, correction rates, JOA scores, SRS-22 questionnaire wereevaluated preoperatively, postoperatively, and at the final visit. Fusion rates,complications and quality of fusion were recorded.METHODS: 4 groups of patients were generated. Only posterolateral fusion, neuraldecompression, and sagittal plane correction with posterior instrumentation using 3rdgeneration instrumentation system transpedicular screws was accomplished in 20patients (low dysplastic: 10 patients, high dysplastic: 10 patients). Additional reductionof anterior slippage was done in the remaining 20 patients (low dysplastic: 10 patients,high dysplastic: 10 patients).RESULTS: No statistically significant difference was found between low vs. highdysplastic patients and between patients with sagittal contour realignment vs. patientswith additional anterior slippage reduction (p>0.05). The correction rates fordisplacement were statistically similar at the final visit. Postoperative and final JOAand SRS scores were similar between in situ fusion and reduction groups (p>0.05). Asolid fusion mass of 77.5 % was achieved in both groups.CONCLUSIONS: A high percentage of fusion was achieved with posterolateral insitu fusion with or without reduction; and an additional reduction procedure did nothave a statistically detectable impact on clinical outcomes. Successful fusion and neuraldecompression were the most important parameters that have an impact on clinical outcomes in patients with developmental spondylolisthesis, irrespective of the extent ofpreoperative displacement and the type of listhesis.
- 神戸大学医学部の論文
- 2006-12-00
神戸大学医学部 | 論文
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