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Mukesh Agarwal ¹, Sandeep Pangavane ², Nimesh Nebhani ³, Ameya Kulkarni ³, Nitish Agarwal ³, Yogesh Rathod ³

Affiliations
1 Associate Professor, Department of Orthopedics, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik – 422003, IN
2 Professor and Head, Department of Orthopedics, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik – 422003, IN
3 Former PG Resident, Department of Orthopedics, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik – 422003, IN

Abstract

Background: Primary lumbar vertebral instability or “spondylolisthesis” is perhaps one of the commonest radiological sign associated with lumbo-sacral pain after the third decade of life. Aims and Objectives: To find out the functional outcome in terms of clinical improvement in cases of single level lumbar spondylolisthesis by bone grafting and interbody cage fusion and pedicle screw fixation after decompression of neural elements. Materials and Methods: All the patients were evaluated by anteroposterior and lateral radiographs of the lumbosacral spine centered at the appropriate level. In all cases flexion and extension views were taken to assess the instability. More than 4 to 5 mm of sagittal translation and 10 degrees of rotation were considered as instability. All cases were evaluated further by MRI to evaluate facet joint pathology, sacralization/lumbarisation and to find the associated disc changes and the nerve root involvement. All patients were treated by decompression and interbody fusion with cage and bone graft by either Transforaminal or Posterior approach and instrumentation done with pedicle screws. Post operatively all patients were assessed for the functional outcome using the Oswestry Disability Index at 1 month, 3 month and 6 months Results: There is statistically significant difference in ODI Scores (Oswestry Disability Index) post operatively at 1 month, 3 month and 6 months. Conclusion: In agreement with good results, found in our study, we strongly believe that this technique of fusion and instrumentation is very useful in management of lumbar spondylolisthesis. However, this study should further be extended to a wider sample of patients with a longer follow-up.

Keywords

Back Pain, Interbody Cage fusion, ODI Score, Spondylolisthesis

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Vishal Gautam Harkar ¹, Mukesh Agarwal ², Kaustubh Satish Devasthali ¹, Vishwesh Devendrasinh Chudasama ¹, Shubham Siddheshwar Zade Siddheshwar Zade ¹

Affiliations
1 Former PG Resident, Department of Orthopaedics, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik – 422003, Maharashtra, IN
2 Associate Professor, Department of Orthopaedics, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik – 422003, Maharashtra, IN

Abstract

Background: Lumbar interbody fusion is the most reliable fusion technique currently available for the lumbar spine as these constructs are biomechanically stronger, provide axial support with less graft subsidence or collapse comparing to those with posterolateral arthrodesis, and produce a better biologic fusion in lordotic alignment1, 2 . Aims and Objectives: To study functional outcome of posterior lumbar interbody fusion technique with implant in degenerative spondylolisthesis at L4 and L5 level. Materials and Methods: The study was carried on 34 patients enlisting in the casualty or inpatient department of orthopaedics at a medical college and tertiary health care centre. Only those patients satisfying the inclusion and exclusion criteria were included in the study. All the patients were explained about the surgical procedure, the purpose of the study and Informed consent was taken. Results: As per Japanese Orthopaedic Association score, Normal results were observed in none of the cases while grade I, II and III was observed in 73.5%, 20.6% and 5.9% cases. Post-op results were observed as normal in 64.7% while Grade I, II and III was observed in 32.4% and 2.9% cases respectively (p<0.01). Conclusion: Present study concluded that although, long-term role of deformity correction and restoration of lumbar spinal balance in cases of spondylolisthesis is yet to be determined, the current study appears to indicate that satisfactory radiological correction of degenerative focal sagittal deformity can be achieved with the insert and-rotate PLIF technique. There appeared to be high levels of patient satisfaction in this relatively short-term study and low levels of complications. Longer-term and comparative clinical outcome studies are required.

Keywords

Degenerative Spondylolisthesis, Posterior Lumbar Interbody Fusion Technique, Japanese Orthopaedic Association Score

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