Fusion and clinical outcomes of lumbar interbody fusion for low-grade isthmic spondylolisthesis.

Autor: Ould-Slimane M; Department of Orthopedic Surgery, Spine Unit, Rouen University Hospital, Rouen, France. Electronic address: mourad.ould-slimane@chu-rouen.fr., Prost S; Aix-Marseille Université, AP-HM, CNRS, ISM, CHU Timone, Unité de Chirurgie Rachidienne, 264, rue Saint-Pierre, 13005 Marseille, France., d'Astorg H; Centre Orthopédique Santy, Hôpital Privé Jean-Mermoz, Ramsay Générale de Santé, Lyon, France., Lalevée M; Department of Orthopedic Surgery, Spine Unit, Rouen University Hospital, Rouen, France., Blondel B; Aix-Marseille Université, AP-HM, CNRS, ISM, CHU Timone, Unité de Chirurgie Rachidienne, 264, rue Saint-Pierre, 13005 Marseille, France., Szadkowski M; Centre Orthopédique Santy, Hôpital Privé Jean-Mermoz, Ramsay Générale de Santé, Lyon, France., Fuentes S; Aix-Marseille Université, AP-HM, CNRS, ISM, CHU Timone, Unité de Chirurgie Rachidienne, 264, rue Saint-Pierre, 13005 Marseille, France., Collinet A; Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Hautepierre 2, 1, avenue Molière, 67200 Strasbourg, France., Parent HF; Clinique Saint-Léonard, 18, rue de Bellinière, 49800 Trélazé, France., Litrico S; Department of Spine Surgery, Pasteur II Hospital, Centre Hospitalo-Universitaire de Nice, Nice, France., Grelat M; Dijon University Hospital, Department of Neurosurgery, Dijon, France., Zairi F; Ramsay Générale de Santé, Hôpital Privé Le Bois, 59000 Lille, France., Charles YP; Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Hautepierre 2, 1, avenue Molière, 67200 Strasbourg, France., Giorgi H; Institut Méditerranéen du Dos, Marseille, France.
Jazyk: angličtina
Zdroj: Orthopaedics & traumatology, surgery & research : OTSR [Orthop Traumatol Surg Res] 2023 Apr; Vol. 109 (2), pp. 103508. Date of Electronic Publication: 2022 Dec 07.
DOI: 10.1016/j.otsr.2022.103508
Abstrakt: Introduction: Low-grade isthmic spondylolisthesis (ISPL) is generally treated by circumferential fusion with interbody graft, although there is no consensus on technique.
Hypothesis: The various interbody fusion strategies provide satisfactory fusion rates and clinical results.
Methods: A multicenter retrospective study analyzed lumbar interbody fusion for low-grade ISPL performed between March 2016 and March 2019. Techniques comprised: circumferential fusion on a posterior or a transforaminal approach (PLIF, TLIF: n=57), combined anterior (ALIF)+posterolateral fusion (ALIF+PLF: n=60), and ALIF+percutaneous posterior fixation (ALIF+PPF: n=55). Function was assessed on a lumbar and a radicular visual analog scale (AVS-L, VAS-R), Oswestry Disability Index (ODI) and Short Form 12 (SF12).
Results: Among the 129 patients, 85.3% showed fusion (Lenke 1 or 2), with no significant differences between the ALIF-PLF or ALIF-PPF groups and the PLIF or TLIF groups (p=0.3). Likewise, there was no difference in fusion rates between the ALIF-PPF and ALIF-PLF subgroups (p=0.28). VAS-L (p<0.001) and VAS-R (p<0.0001), ODI (p<0.001) and SF12 physical (PCS) (p<0.01) and mental component sores (MCS) (p<0.001) all showed significant improvement at 12months. Combined approaches provided greater clinical efficacy than TLIF or PLIF for lumbar (p<0.0001) and radicular pain (p<0.05), ODI (p<0.0001) and SF12 PCS (p<0.01). At 12months, there was no clinical difference between the ALIF-PPF and ALIF-PLF subgroups. However, patents with interbody non-union (Lenke 3 or 4) had lower SF12 PCS scores (p<0.004) and VAS-L ratings (p<0.001) than Lenke 1-2 patients.
Conclusion: Low-grade ISPL treated by circumferential arthrodesis and interbody graft showed 85.3% consolidation at 2years, with equivalent outcomes between anterior and posterior techniques. Successful fusion was associated with better clinical results.
Level of Evidence: IV.
(Copyright © 2022. Published by Elsevier Masson SAS.)
Databáze: MEDLINE
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