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Background Data: Several controversies exist over the most appropriate approach for managing high grade spondylolisthesis; classic interbody fusions (PLIF) are associated with a considerable degree of complications. Purpose: The aim of this work is to determine the safety and efficacy of unilateral...

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Autores principales:	Wael Koptan, Yasser ElMiligui, Mohamad El-Sharkawi, Mohmad Ramadan
Formato:	article
Lenguaje:	EN
Publicado:	Egyptian Spine Association 2012
Materias:	high grade Spondylolisthesis Transforaminal interbody fusion Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/613f148754054523b65bc19f7e11b7b1
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spelling	oai:doaj.org-article:613f148754054523b65bc19f7e11b7b12021-12-02T00:32:11Zhttp://esj.journals.ekb.eg/article_3760.htmlDOI:10.21608/ESJ.2012.37612314-89502314-8969https://doaj.org/article/613f148754054523b65bc19f7e11b7b12012-01-01T00:00:00Zhttp://esj.journals.ekb.eg/article_3761.htmlhttps://doaj.org/toc/2314-8950https://doaj.org/toc/2314-8969Background Data: Several controversies exist over the most appropriate approach for managing high grade spondylolisthesis; classic interbody fusions (PLIF) are associated with a considerable degree of complications. Purpose: The aim of this work is to determine the safety and efficacy of unilateral TLIF in managing high grade isthmic spondylolisthesis.Study Design: Prospective, randomized, between 2000 and 2008. Patient Sample:44 patients with high grade isthmic spondylolisthesis (Meyerding grades III and IV).The mean age was 24y (range 17-38y). All patients had severe back and radicular symptoms that failed to conservative treatment. Eighteen were at L4/5 and 26 at L5/S1. Outcome measures; total blood loss, operative time and hospital stay were recorded. Clinical outcome was assessed by the ODI and VAS. Fusion was assessed using plain radiographs.Methods: Limited decompression and indirect instrumented reduction was performed; 21 had additional unilateral TLIF (Group 1) and 23 had posterolateral fusion using autograft bone (Group 2). Patients were followed-up for an average of 4.5y (range 2-7y). Results: The average Oswestry Disability Index and Visual Analogue Scale showed better improvement in group 1 than group 2. In group 1 anterolisthesis improved from an average of 69% to 16% while in Group 2 it improved from an average of 64% to 19% at final follow up. Other parameters including improvement in disc space height, lumbar lordosis and angle of slip showed better improvement in group 1 than group 2. None in Group 1 had an implant failure and its overall fusion rate was 94%. In Group 2, the average operative time, blood loss and hospital stay were significantly less but two patients had implant failure requiring revision and the overall complications were 6/23 patients. Conclusion: Direct instrumented reduction and TLIF is an efficient option to treat high grade isthmic spondylolisthesis. It provided immediate stability and superior clinical and radiological outcomes.(2012ESJ005)Wael KoptanYasser ElMiliguiMohamad El-SharkawiMohmad RamadanEgyptian Spine Associationarticlehigh gradeSpondylolisthesisTransforaminalinterbody fusionNeurology. Diseases of the nervous systemRC346-429ENEgyptian Spine Journal, Vol 1, Iss 1, Pp 49-56 (2012)
institution	DOAJ
collection	DOAJ
language	EN
topic	high grade Spondylolisthesis Transforaminal interbody fusion Neurology. Diseases of the nervous system RC346-429
spellingShingle	high grade Spondylolisthesis Transforaminal interbody fusion Neurology. Diseases of the nervous system RC346-429 Wael Koptan Yasser ElMiligui Mohamad El-Sharkawi Mohmad Ramadan http://esj.journals.ekb.eg/article_3760.html
description	Background Data: Several controversies exist over the most appropriate approach for managing high grade spondylolisthesis; classic interbody fusions (PLIF) are associated with a considerable degree of complications. Purpose: The aim of this work is to determine the safety and efficacy of unilateral TLIF in managing high grade isthmic spondylolisthesis.Study Design: Prospective, randomized, between 2000 and 2008. Patient Sample:44 patients with high grade isthmic spondylolisthesis (Meyerding grades III and IV).The mean age was 24y (range 17-38y). All patients had severe back and radicular symptoms that failed to conservative treatment. Eighteen were at L4/5 and 26 at L5/S1. Outcome measures; total blood loss, operative time and hospital stay were recorded. Clinical outcome was assessed by the ODI and VAS. Fusion was assessed using plain radiographs.Methods: Limited decompression and indirect instrumented reduction was performed; 21 had additional unilateral TLIF (Group 1) and 23 had posterolateral fusion using autograft bone (Group 2). Patients were followed-up for an average of 4.5y (range 2-7y). Results: The average Oswestry Disability Index and Visual Analogue Scale showed better improvement in group 1 than group 2. In group 1 anterolisthesis improved from an average of 69% to 16% while in Group 2 it improved from an average of 64% to 19% at final follow up. Other parameters including improvement in disc space height, lumbar lordosis and angle of slip showed better improvement in group 1 than group 2. None in Group 1 had an implant failure and its overall fusion rate was 94%. In Group 2, the average operative time, blood loss and hospital stay were significantly less but two patients had implant failure requiring revision and the overall complications were 6/23 patients. Conclusion: Direct instrumented reduction and TLIF is an efficient option to treat high grade isthmic spondylolisthesis. It provided immediate stability and superior clinical and radiological outcomes.(2012ESJ005)
format	article
author	Wael Koptan Yasser ElMiligui Mohamad El-Sharkawi Mohmad Ramadan
author_facet	Wael Koptan Yasser ElMiligui Mohamad El-Sharkawi Mohmad Ramadan
author_sort	Wael Koptan
title	http://esj.journals.ekb.eg/article_3760.html
title_short	http://esj.journals.ekb.eg/article_3760.html
title_full	http://esj.journals.ekb.eg/article_3760.html
title_fullStr	http://esj.journals.ekb.eg/article_3760.html
title_full_unstemmed	http://esj.journals.ekb.eg/article_3760.html
title_sort	http://esj.journals.ekb.eg/article_3760.html
publisher	Egyptian Spine Association
publishDate	2012
url	https://doaj.org/article/613f148754054523b65bc19f7e11b7b1
work_keys_str_mv	AT waelkoptan httpesjjournalsekbegarticle3760html AT yasserelmiligui httpesjjournalsekbegarticle3760html AT mohamadelsharkawi httpesjjournalsekbegarticle3760html AT mohmadramadan httpesjjournalsekbegarticle3760html
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