Comparative analysis of surgical methods for the treatment of grade I and II spondylolisthesis of the L5 vertebra

Abstract

Objective. To analyze clinical and radiological results of surgical treatment of patients with isthmic spondylolisthesis of the L5 vertebra using anterior axial fusion and transpedicular stabilization with interbody fusion performed through the posterior approach.Material and Methods. The study involved 71 patients with isthmic grade I and II spondylolisthesis of the L5 vertebra. The patients were divided into two groups: the study group included 25 patients, and the control group – 46. All patients of the study group underwent presacral axial fusion. Patients in the control group underwent transpedicular stabilization combined with TLIF. The results of surgical treatment of patients were assessed using the MacNab scale, the ODI questionnaire and the VAS scale, and the severity of neurological disorders was assessed using the Francel scale.Results. The duration of surgical intervention in the study group averaged 67 ± 23 min, and in the control group – 135 ± 45 min. The length of hospital stay in the study group was 3 ± 1 days, and in the control group – 5 ± 2 days. Good results were obtained in all cases. In the postoperative period, the average indicators of pain syndrome in the study group after 14 days were 2.0 ± 1.0 points, after 1 month – 1.0 ± 0.7 points and after 1 year – 0.5 ± 0.5 points, and in the control group 2.5 ± 0.5 points, 2 ± 1 points and 0.5 ± 0.3 points, respectively. The average indicators of the general condition in the study group according to the ODI after 14 days was 32.3 ± 8.1 %, after 1 month – 8.1 ± 4.4 % and after 1 year – 4.3 ± 1.8 %, and in the control group 30.2 ± 5.2 %, 6.3 ± 2.2 % and 2.1 ± 1.9 %, respectively. When assessing the duration of the surgical intervention, it turned out that performing presacral axial fusion reduced the duration of the operation by 2 times, and the length of the hospital stay – by 1.5 times.Conclusion. The results of surgical treatment of patients with grade I and II isthmic spondylolisthesis without sagittal imbalance using transpedicular fixation combined with TLIF and those using presacral axial fusion are comparable. However, due to reducing intraoperative trauma, the method of presacral axial fusion allows to reduce the surgery duration and the length of hospital stay.