Boktor Joseph, Ninan Tishi, Pockett Rhys, Collins Iona, Sultan Ahmed, Koptan Wael
Department of Orthopedic, Kasr Al Ainy Medical School, Cairo University, Egypt.
Department of Spine Surgery, Morriston Hospital, Swansea, SA6 6NL, UK.
J Craniovertebr Junction Spine. 2018 Apr-Jun;9(2):101-106. doi: 10.4103/jcvjs.JCVJS_20_18.
This study was a retrospective observational study.
The purpose of the study was to determine the radiological and clinical outcome of using locally sourced autologous bone graft in the surgical management of single-level lumbar lytic spondylolisthesis.
Many spinal surgeons supplement pedicle screw fixation of lumbar spondylolisthesis with cages. In developing countries, the high cost of interbody cages has precluded their use, with surgeons resorting to filling the interbody space with different types of bone graft instead. This study reports on the clinical and radiological outcome of posterior lumbar interbody fusions for low-grade lytic spondylolisthesis using locally sourced autologous bone graft.
Posterior interbody fusion was performed in 22 consecutive patients over 18-month period, using (BRAND) pedicle screw system and locally sourced bone graft, i.e., bone removed during neural decompression. There were no postoperative restrictions, and all patients underwent clinical outcome measurements using Oswestry Disability Index (ODI), visual analogue pain score (VAS) at a minimum follow-up of 12 months, and computed tomography (CT) assessment of fusion with intraobserver validation by radiology consultant blinded, at 6 and12 months. Nearly 50% of the population were smokers.
There was significant clinical improvement in ODI, VAS back pain, and VAS leg pain ( < 0.001). By contrast, the radiologic fusion rate measured by CT at 12 months was less satisfactory at 64%. There was no difference in clinical outcome between the fused group and nonfused population.
These results indicate that the use of locally sourced bone graft in single-level lumbar lytic low-grade spondylolisthesis. Interbody fusion provides good clinical outcomes. The use of an interbody cage may not be clinically necessary. Our radiologic outcome, however, shows inferior fusion rates compared with published data. Future research will focus on long-term outcomes.
本研究为回顾性观察性研究。
本研究的目的是确定在单节段腰椎溶解性椎体滑脱的手术治疗中使用本地获取的自体骨移植的放射学和临床结果。
许多脊柱外科医生在腰椎椎体滑脱的椎弓根螺钉固定中使用椎间融合器。在发展中国家，椎间融合器的高成本使其无法使用，外科医生转而使用不同类型的骨移植来填充椎间间隙。本研究报告了使用本地获取的自体骨移植进行后路腰椎椎间融合治疗低度溶解性椎体滑脱的临床和放射学结果。
在18个月期间，对22例连续患者进行了后路椎间融合术，使用（品牌）椎弓根螺钉系统和本地获取的骨移植，即神经减压时切除的骨。术后没有限制，所有患者在至少12个月的随访中使用Oswestry功能障碍指数（ODI）、视觉模拟疼痛评分（VAS）进行临床结果测量，并在6个月和12个月时通过放射科顾问进行观察者内验证的计算机断层扫描（CT）评估融合情况。近50%的人群为吸烟者。
ODI、VAS背痛和VAS腿痛有显著的临床改善（<0.001）。相比之下，12个月时通过CT测量的放射学融合率较低，为64%。融合组和未融合人群的临床结果没有差异。
这些结果表明，在单节段腰椎溶解性低度椎体滑脱中使用本地获取的骨移植。椎间融合提供了良好的临床结果。使用椎间融合器在临床上可能没有必要。然而，我们的放射学结果显示融合率低于已发表的数据。未来的研究将集中在长期结果上。
