退行性和峡部裂性腰椎滑脱患者椎旁肌肉组织退变的影像学比较

背景:现有研究已对退行性腰椎滑脱患者与健康人群椎旁肌肉退变程度的差异进行了比较,但还缺乏不同腰椎滑脱症种类之间影像参数差异的比较研究。目的:探讨峡部裂性腰椎滑脱与退行性腰椎滑脱患者在椎旁肌肉组织退变方面的差异,以及与腰背痛症状的相关性。方法:对2019年2月至2023年8月在徐州医科大学附属医院治疗的107例腰椎滑脱患者进行回顾性分析,根据滑脱类型将患者分为2组,峡部裂性腰椎滑脱组39例,退行性腰椎滑脱组68例。对比分析两组患者椎旁肌组织影像学参数情况以及腰背痛目测类比评分,依据目测类比评分,将两组患者分别分为目测类比评分≤45 mm和>45 mm两个亚组,分析目测类比评分差异与椎旁肌肉组织退变参数的关系。结果与结论:①退行性腰椎滑脱组患者多裂肌的脂肪浸润百分比高于峡部裂性腰椎滑脱组(P=0.003);②两组腰背痛目测类比评分≤45 mm的患者多裂肌脂肪浸润百分比低于腰背痛目测类比评分>45 mm患者(P=0.021,P<0.001);③峡部裂性腰椎滑脱组还表现出腰背痛目测类比评分≤45 mm的患者竖脊肌脂肪浸润百分比低于腰背痛目测类比评分>45 mm患者(P=0.002);④结果显示,峡部裂性腰椎滑脱患者和退行性腰椎滑脱患者在椎旁肌肉组织退化方面存在显著差异,且退行性腰椎滑脱患者相比峡部裂性腰椎滑脱患者展现出更为严重的椎旁肌退化;此外,两组腰椎滑脱患者中,疼痛较严重者的多裂肌脂肪浸润程度相对较高。

峡部裂腰椎滑脱患者椎旁肌对脊柱-骨盆矢状面的影响:肌肉数量和质量的评估

背景:横截面积和脂肪浸润为量化椎旁肌的标准参数,但是太过繁琐和费时,需要引入新的量化指标。目的:探讨峡部裂性腰椎滑脱患者椎旁肌和脊柱-骨盆矢状面参数测量值之间的关系,以及腰椎压痕值对矢状面平衡的预测价值。方法:选择诊断为峡部裂性腰椎滑脱的患者87例,均为Meyerding分型Ⅱ度滑脱,男40例,女47例,平均年龄(51.4±9.1)岁。测量患者脊柱-骨盆矢状面参数矢状面轴向距离、骨盆入射角、骨盆倾斜角、骶骨倾斜角、腰椎前凸角、胸椎后凸角、骨盆投射角与腰椎前凸角之差,以及腰椎旁肌的总横截面积、功能横截面积和脂肪浸润。使用Pearson相关分析法探讨矢状面参数与椎旁肌测量值的相关性;使用多元线性回归分析腰椎压痕值、年龄、性别和体质量指数对脊柱骨盆矢状面平衡的影响。通过受试者工作特征曲线寻找腰椎压痕值的最佳截断点,评价矢状面轴向距离和骨盆投射角与腰椎前凸角之差的关系。结果与结论:(1)根据Pearson相关分析结果,多裂肌总横截面积与腰椎前凸角(r=0.464,P <0.01)和骨盆投射角与腰椎前凸角之差(r=-0.306,P <0.01)显著相关;多裂肌功能横截面积与腰椎前凸角(r=0.367,P <0.01)和骨盆投射角与腰椎前凸角之差(r=-0.228,P <0.05)存在显著相关性;腰椎压痕值与矢状面轴向距离(r=-0.300,P <0.01)、腰椎前凸角(r=0.417,P <0.01)、胸椎后凸角(r=0.351,P <0.01)和骨盆投射角与腰椎前凸角之差(r=-0.319,P <0.01)有显著相关性;(2)根据多元线性回归分析结果,腰椎压痕值和骨盆投射角与腰椎前凸角之差以及矢状面轴向距离独立相关;腰椎压痕值≤11.5 mm的患者矢状面轴向距离≤50 mm发生率为55%(11/20),而腰椎压痕值> 11.5 mm的患者矢状面轴向距离≤50 mm发生率为96%(64/67);骨盆投射角与腰椎前凸角之差≤11.5 mm的患者骨盆投射角与腰椎前凸角之差≤10°的发生率为30%(6/20),而腰椎压痕值> 11.5 mm的患者骨盆投射角与腰椎前凸角之差≤10°的发生率为66%(44/67);(3)提示多裂肌总横截面积和功能横截面积均与腰椎前凸角和骨盆投射角与腰椎前凸角之差显著相关;腰椎压痕值作为评价椎旁肌退变的新指标,与矢状面轴向距离和骨盆投射角与腰椎前凸角之差独立相关,对术后矢状面矫正有一定的预测价值,是一种简单实用的评估脊柱-骨盆矢状面和椎旁肌退变的方法;椎旁肌的退变与脊柱-骨盆矢状面平衡有关。

Trans-sacral screw fixation in the treatment of high dyplastic developmental spondylolisthesis

We describe the case of a 67-year-old woman with L5-S1 ontogenetic spondylolisthesis treated with pedicle fixation associated with interbody arthrodesis performed with S1-L5 trans-sacral screwing according to the technique of Bartolozzi. The procedure was followed by a wide decompressive laminectomy. The patient had a progressive improvement of the symptoms which gradually disappeared in 12 mo. The radiograph at 6 and 12 mo showed complete fusion system. The choice of treatment in L5-S1 ontogenetic spondylolithesis is related to a correct clinical and diagnostic planning(X-ray, computer tomography magnetic resonance imaging, Measurement). In particular, the severity index and the square of unstable zone, and the standard measurements already described in the literature, are important to understand and to plane the correct surgical strategy, that require, in most of the times, fusion and interbody artrodesis.

OUTCOME OF POSTEROLATERAL FUSION VERSUS CIRCUMFERENTIAL FUSION WITH CAGE FOR LUMBAR STENOSIS AND LOW DEGREE LUMBAR SPONDYLOLISTHESIS

Objective To evaluate the outcome of two methods for stabilization and fusion: posterolateral fusion and circumferential fusion involving posterior lumbar interbody fusion for lumbar stenosis with Grades 1 and 2 lumbar spondylolisthesis.Methods From April 1998 to April 2003, 45 patients suffering from lumbar stenosis with low degree lumbar spondylolisthesis treated in our hospital were retrospectively reviewed and assigned to two groups.Among them, 24 patients (group A) were treated with instrumented posterolateral fusion and 21 patients (group B) with instrumented circumferential fusion.The two groups were compared for clinical and radiological outcomes.Results All patients were followed up for 12 to 72 months.In group A, results showed preoperative clinical symptoms disappeared completely in 12 of 24 patients, and pain relief was seen in 91.7% (22/24).Two cases suffered from residual symptoms.Twenty-two cases obtained complete reduction of olisthy vertebral bodies, and anatomical reduction rate was 91.7%.No infection or neurological complication occurred in this group.In group B, results showed preoperative clinical symptoms disappeared completely in 13 of 21 patients, and pain relief was seen in 90.5% (19/21).One case suffered from residual symptoms.Twenty cases obtained complete reduction of the olisthy vertebral bodies, and anatomical reduction rate was 95.2%.Four cases of infection or neurological complication occurred in this group.Both groups indicated no significant difference in clinical outcomes and anatomical reduction rate during follow-up.But group A had better intraoperative circumstances and postoperative outcome than group B, while group B had better postoperative parameters in X-ray of Angle of Slipping and Disc Index than group A.Conclusions The first choice of surgical method for lumbar stenosis with low degree lumbar spondylolisthesis is instrumented posterolateral fusion.Only when patients suffer from severe preoperative disc degeneration and low back pain or intervertebral instability should we consider indications for additional use of CAGE.

Combining Posterolateral Lumbar Fusion and Posterior Lumber Interbody Fusion Surgery for Treating Three-Level Lumber Spondylolysis and Single-Level Spondylolisthesis: Case Report

Lumbar spondylolysis is a relatively common condition that can cause a variety of clinical manifestations related to the lumbar spine. However, multi-level lumbar spondylolysis is rare and accounts for less than 6% of lumbar spondylolysis. We report a case of three-level lumbar spondylolysis with single-level spondylolisthesis. A 47-year-old woman presented to us with low back pain for 9 years that progressively worsened and the pain was exacerbated with standing and walking. She was diagnosed with three-level lumbar spondylolysis at L3-5 and spondylolisthesis at L4. We performed posterolateral lumber fusion (PLF) and posterior lumbar interbody fusion (PLIF) surgery for her. During the same period, pain recovery and fusion rate of the patient were evaluated after surgery. The results were favorable and proved the efficacy of combining PLF and PLIF technique for treatment for three-level lumbar spondylolysis and single-level spondylolisthesis.

Analysis of Degenerative Discs in Lumbar Spondylolisthesis Using MRI T2 Mapping

Background: Spinal instability, including lumbar degenerative spondylolisthesis (DS), mainly results from degeneration of intervertebral discs (IVD) and the facet joints (FJ). Characterization of the relationship between IVD degeneration in cases of lumbar degenerative spondylolisthesis (DS), and T2 values may be useful for accurate noninvasive evaluation and subsequent treatment. Thus, the goal of this study was to measure T2 values of IVDs in cases with (DS) and without (NS) spondylolisthesis, and to characterize changes of IVDs in DS. Methods: A total of 40 subjects who presented with L4 spondylolisthesis comprised the DS group. Another 40 subjects who did not have lumbar spondylolisthesis, constituted the NS group. T2 values of IVDs were measured and compared in these groups. Results: T2 values for IVDs tended to be lower in the DS group than in the NS group, and these values were significantly different (p < 0.01) within the anterior annulus fibrosus (AF). No significant differences in T2 values between Meyerding grades I and II were observed in any areas of IVDs. Conclusions: It is speculated that in the early stages, the degeneration of the anterior AF develops and is related to the onset of lumbar spondylolisthesis, while in later stages, degeneration of facet joints influences the progression of spondylolisthesis.

Meta-Analysis of Clinical Outcomes of Lumbar Fusion Surgical Interventions for Degenerative Spondylolisthesis

Introduction: Surgical interventions for degenerative spondylolisthesis are varied with comparable claims of success. Fusion based technique is one of the most commonly used surgical interventions in treating this condition. The aim of this meta-analysis is to compare the effectiveness of the Lumbar Interbody Fusion techniques (specifically Posterolateral Interbody approach—PLIF) versus Posterolateral Instrumented Fusion (PLF). The clinical outcomes investigated were: back pain, leg pain, function, Oswestery Disability Index (ODI), Disability Rating Index (DRI), fusion and revision rates if reported. Methods: Combinations of keywords and MeSH terms, where appropriate, were used to search for studies in Medline via Ovid, Embase, Cochrane Library, and Google scholar. The initial search was conducted on 10 August 2016 and updated on 13 June 2017. Eligibility criteria for the studies to be selected for this meta-analysis were: Randomised Controlled Trials (RCTs), cohort and consecutive cases studies that compared at PLIF versus PLF surgical interventions at the lumbar region. Heterogeneity indicators and Forest plot were computed using RevMan 5. Results: Out of the initial hits of 3021, 5 articles were selected as relevant and assessed for risk of bias and then data was extracted and tabulated. These 5 studies reported data from (900 patients’ records, follow up ranges from 6 months to 5 years) undergone one of 2 interventions (PLIF or PLF). The overall effect for ODI and leg pain showed no advantage of any intervention over the other while there was a greater odd ratio of fusion if the operation applied PLIF techniques (Overall Z = 2.86, p = 0.004). Conclusions: There is a need for more high quality clinical trials to compare these two interventions. However, available data indicate that there are comparable results in the main clinical outcomes between PLIF and PLF. PLIF has superior fusion rate which does not seem to affect post-operative pain ratings.

Application of 3D printing technique in pedicle screw placement for the lumbar isthmic spondylolisthesis

Objective:To investigate the application value of 3D printing technique in the operation of the lumbar isthmic spondylolisthesis.Methods Totally 48 patients with lumbar isthmic spondylolisthesis treated in our department from January 2015 to April 2017 were selected in the research plan.According to the random digital table method,they were divided into the observation group and the control group,with 25 cases in the observation group and 23 cases in control group.All patients were treated with transforaminal lumbar interbody fusion(TLIF).The control group made the observation group made the operation plan with 3D printing technology,and the operation plan according to the 3D CT reconstruction image.The clinical and imaging results were compared between the two groups、including operation time、intraoperative blood loss and X-ray exposure、complications、preoperative and postoperative ODI and JOA score.Results The accuracy of the screw placement in the observation group was 95.33%,which was significantly higher than those of 84.06%in the control group,the differences were statistically significant(P<0.05).Operation time and X-ray exposure and intraoperative blood loss in observation group were less than those in the control group,the differences were statistically significant(P<0.05).There were no significant differences spondylolisthesis reduction degree、ODI and JOA scores at postoperative different point between groups(P>0.05).Conclusions 3D printing technology is helpful to the development of the lumbar isthmic spondylolisthesis surgical plan,with the advantages of shortening the operation time and X-ray exposure,reducing the blood loss,improving the accuracy of the screw placement.

Surgical Management of Spondylolisthesis by Pedicular Screw Rod System and Postero-Lateral Fusion

Introduction: Incidence of spondylolisthesis in general population is 5% - 7%. No matter what the etiology is, patients usually have significant functional disability. Few studies have investigated the long term effect of posterolateral fusion on functional outcome. Objectives: To study the efficacy of posterolateral fusion in spondylolisthesis especially in terms of functional outcome. Methodology: From July 2010 to June 2012, a total of 86 patients, operated with postero-lateral fusion were followed up and evaluated based on VAS for low back pain, ODI and neurological deficits. Results: Follow up was 83% of original study population (86). Average follow up was 13 months. The mean difference between pre-operative and post-operative VAS at final follow up was 3.5 cms (SD = 2.94);ODI was 28% at 4 months and 36% at 8 months. Claudication pain relieved in all;functional outcome was good in 67%, fair in 27.5% and failed in 5.5%;75% had fusion at an average of 5.5 months. Conclusion: Posteriolateral fusion is still a safe, promising and appealing technique.

SURGICAL TREATMENT OF SPONDYLOLISTHESIS WITH SOCON INSTRUMENTATION

To observe the clinical outcomes of using a new instrumentation SOCON system in the treatment of degenerative spondylolisthesis. Methods. Retrospective clinical and roentgenograph review of 21 patients who suffered from degenerative spondylolisthesis with spinal stenosis treated by decompression, posterolateral intertransverse arthrodesis, and with transpedicle instrumentation of SOCON system. Results.Nineteen of 21 patients were completely recovery from their preoperative symptoms, 17 of 18 cases with grade one slippage reduced to normal spine alignment, 2 cases of grade two slippage fully reduced, and one case of grade two spondylolisthesis got 70% reduction. Post operative satisfactory rate was 90.5%. Pain relief was 90.5%. Neither infection nor neurologic complication occurred in this series. Conclusion. Our short time followup and limited cases showed satisfactory preliminary result of surgical treatment of spondylolisthesis with SOCON instrumentation.

Surgical Results of Posterior Lumbar Interbody Fusion with Transpedicular Fixation in Management of Spondylolisthesis

Objective: To evaluate the surgical results of posterior lumber interbody fusion with transpedicular fixation with rod screw system in management of spondylolisthesis. Study Design: Retrospective study reviewed all patient treated by lumber interbody fusion with transpedicular fixation with rod screw system. Patients and Methods: They were 40 patients operated for lumber and lumbosacral spondylolisthesis from Feb 2014 to April 2017 in Al-Azhar university hospital. These patients followed postoperatively clinically for improved neural function and for fusion stability and hardware fixation by radiological investigation. Data about pain intensity (by Visual Analogue Scale) was collected pre- and postoperatively;and outcome was assessed by Oswetry disability index (ODI). Outcome was graded as excellent, good, fair, or poor. Pre- and Post-operative data were statistically compared. Results: The mean age was 45 years (range between 30 - 60 years) with female sex predominance (male:female = 1:3). They had lytic (n = 30) or degenerative (n = 10) spondylolisthesis;and all underwent PLIF (posterior lumbar interbody fusion). In lytic group, the level was L4/L5 in 19 patients and L5/S1 in 11 patients, while in degenerative group the level was L4/L5 in 4 patients, L5/S1 in 3 patients, L2/L3 in 2 and L3/L4 in one patient. The spondylolisthesis grade was grade I among 25 subjects, grade two among 11 subjects and retrolisthesis among 4 subjects. Sensory deficits reported in 22 subjects (19 had lytic and 3 had degenerative spondylolisthesis);while motor deficits reported among 10 subjects and reduced reflexes among 8 subjects. The outcome was excellent, good, and fair among 30, 7, and 3 subjects respectively. The return to previous levels of activity was reported among 32 patients. VAS was 3.5 ± 2.94 at the end of follow up, while ODI was 28% and 36.0% and 3 and 6 months respectively. Conclusion: PLIF associated with transpedicular rod screw fixation system for management of spondylolisthesis is considered a safe and effective surgical intervention in both lytic and degenerative types.

THE DISTRACTION REDUCTION FIXATION SYSTEM AND ITS APPLICATION IN SPONDYLOLISTHESIS

Objective． An internal fixation apparatus—— distraction reduction fixation system(DRFS) was designed to satisfy the clinical needs for spondylolisthesis. Methods. Since 1996, 53 patients were treated with DRFS. Among them, 35 had spondylolisthesis, 12 had lumbar canal stenosis accompanied with instability, 2 had vertebral tumors and 4 suffered from spinal fracture. The average age was 53.6 years old (ranged 24～ 72yrs). The mean time for follow- up was 30.6 months (16～ 44 months). Results． The slip rate was 0.15± 0.10 before operation, and decreased to 0.09± 0.07 after operation. Entire slip reposition was achieved in 19 cases (54.3％ ). The change in height of the intervertebral space within the fixation segments was 0.7± 0.17. Conclusion． DRFS achieved better results for spondylolisthesis less II degree and no other adverse effects were found. Compared with other foreign and domestic techniques, it had advantages in less implants, less operation gears required and ease to utilize in operation. It was proved to be an ideal internal fixation apparatus.

Bohlman Technique Using Rialto Sacroiliac Fusion Implant for Treating L5-S1 High Grade Spondylolisthesis. Report of Two Cases

The article begins with a brief biography of H. Bohlman, a great orthopedist and person with strong impact on modern Medicine and Spine surgery. Using original Bohlamn technique with small modifications (instead of fibula graft used Rialto implant and performed posterior fixation L4-S2) we treated surgically two young females with L5 listhesis with success. Methods: Both patients were followed up during 1 year and 9 months and 1 year and 7 months. Results: Two young females of 18 years old with isthmic listhesis L5 were submitted to fixation L4-S2 and transsacral, transdical fusion with Rialto implant by Bohlman technique with partial reduction of listhesis. Both had resolution of the pain and have maintained a good clinical outcome at 1 year and 9 months and another one at 1 year and 7 months follow up. .

Lumbar Spondylolisthesis in Rheumatological Practice in Lome (Togo): Frequency and Semiological Profile

Objectives: To determine the frequency, the clinical and radiological features of lumbar spondylolisthesis in a rheumatological practice in Lomé. Patients and methods: This was a cross-sectional study conducted in the rheumatology department of the Sylvanus Olympio Teaching Hospital in Lomé between January 1997 and December 2019. Medical records of patients with symptomatic spondylolisthesis with radiographic confirmation were reviewed. The Meyerding classification system was used for grading. Results: Of the 350 patients contacted, 118 consented to participate in the study, making a response rate of 33.71%. Of the 118, 104 (88.1%) were females. 109 (92.4%) presented with radicular pain and 9 (7.6%) presented low back pain. The mean age of the patients was 54.24 ± 11.19 years. The average duration of the pain was 4.56 ± 1.32 years. The spondylolisthesis level most involved was the L4 - L5 (92/118), followed by L5 - S1 (23/118). 106 (89.8%) patients had anterolisthesis only, seven (5.9%) combination anterolisthesis and retrolisthesis. The spondylolisthesis was associated with spondylosis in 110 (93.2%) patients. Spondylosis was found at level L4 - L5 in 38.98% patients, followed by L5 - S1 (24.58%), L3 - L4 (18.64%). Grade I slip was found in 108 (91.53%) patients and Grade II slips 10 (8.47%). Isthmic lysis was found in 40 (33.9%) patients and it was located at L4 in 30 (75.0%). Conclusion: Lumbar spondylolisthesis appears to be expected in Lomé patients with nonspecific back pain and mainly affects females.

Predicting Lumbar Spondylolisthesis: A Hybrid Deep Learning Approach

Spondylolisthesis is a chronic disease,and a timely diagnosis of it may help in avoiding surgery.Disease identification in x-ray radiographs is very challenging.Strengthening the feature extraction tool in VGG16 has improved the classification rate.But the fully connected layers of VGG16 are not efficient at capturing the positional structure of an object in images.Capsule network(CapsNet)works with capsules(neuron clusters)rather than a single neuron to grasp the properties of the provided image to match the pattern.In this study,an integrated model that is a combination of VGG16 and CapsNet(S-VCNet)is proposed.In the model,VGG16 is used as a feature extractor.After feature extraction,the output is fed to CapsNet for disease identification.A private dataset is used that contains 466 X-ray radiographs,including 186 images displaying a spine with spondylolisthesis and 280 images depicting a normal spine.The suggested model is the first step towards developing a web-based radiological diagnosis tool that can be utilized in outpatient clinics where there are not enough qualified medical professionals.Experimental results demonstrate that the developed model outperformed the other models that are used for lumbar spondylolisthesis diagnosis with 98%accuracy.After the performance check,the model has been successfully deployed on the Gradio web app platform to produce the outcome in less than 20 s.

Acute deep venous thrombosis induced by May-Thurner syndrome after spondylolisthesis surgery:A case report and review of literature

BACKGROUND Deep venous thrombosis(DVT)is a serious complication of lumbar spine surgery.Current guidelines recommend pharmacomechanical prophylaxis for patients at high risk of DVT after spine surgery.May-Thurner syndrome(MTS),a venous anatomical variation that may require invasive intervention,is an often overlooked cause of DVT.To date,no case reports of symptomatic MTS caused by isthmic spondylolisthesis or subsequent acute DVT after posterior lumbar surgery have been published.CASE SUMMARY We here present a case of a patient who developed acute DVT 4 h after spondylolisthesis surgery,and MTS was only considered after surgery,during a review of a gynecological enhanced computed tomography image taken before the procedure.CONCLUSION In conclusion,clinicians should consider MTS in the presence of a dangerous triad:spondylolisthesis,elevated D-dimer levels,and sonographically indicated unilateral deep vein dilation.Consultation with a vascular surgeon is also essential to MTS management.

Analysis of influencing factors of clinical effect of TCM treatment for degenerative lumbar spondylolisthesis

Objective:To explore the related factors that may affect the efficacy of traditional Chinese medicine in treating degenerative lumbar spondylolisthesis.Methods:A total of 535 patients with DLS who were treated in Wangjing Hospital of China Academy of Chinese Medical Sciences and other hospitals from June 2011 to October 2014 were selected.The central random system was used to randomly divide the treatment group and control group.This study included 267 patients in the treatment group using the traditional Chinese medicine program((lumbar spine reduction and lumbar spine rehabilitation),36 cases of severely missing data were excluded,and a total of 231 DLS patients were included.Observation indicators were selected using the Visual Analog Scale(VAS)and the Japanese Orthopaedic Association(JOA)for the evaluation of lumbar vertebral disorders.The clinical efficacy was evaluated using the JOA lumbar pain curative effect evaluation standard[7].[(Joa score after treatment-JOA score before treatment]/(out of 29 points-JOA score before treatment)]×100%.The JOA score and the change of the efficacy index of the patients were observed.According to the JOA efficacy index after the treatment,it was divided into significant effect(≥50%)and poor effect(<50%).Single-factor screening and multi-factor Logistic regression analysis were used.Gender,age,course of disease,BMI index,slip-off segment,slip-off direction,back pain VAS score,total JOA score,back pain-score,lower limb pain and numbness-score,walking ability-score,straight leg elevation test-score,Feeling-scoring,muscle strength-scoring,supine turn-scoring,standing action-scoring,washing action-scoring,standing posture and continuous standing-scoring,long sedentary-scoring,weight lifting and holding-scoring,walking-scoring 2.Bladder function-scores were assigned to logistic regression models for univariate analysis,and meaningful independent variables were screened for multivariate logistic regression.Results:No serious adverse reactions occurred in the patients included in this study.According to the comparison of JOA scores before and after treatment,the results of the index of efficacy index showed that the effective rate of DLS in this project was 96.6%,and a significant effect of 77.6%was achieved.Univariate Logistic regression analysis showed that the duration of disease,supine turn-scoring,washing action-scoring,prolonged sedentary-scoring,weight lifting and keeping-scoring had statistically significant effects on the inclusion of patients with significant efficacy(P<0.05);single factor logistic regression analysis of total score of JOA score before treatment was not statistically significant(P=0.215),but because it is important for evaluating the patient's condition,it was included in multifactor logistic regression analysis at the same time.Course of onset,supine turn-scoring,washing action-scoring,prolonged sedentary-scoring,weight lifting and holding-scoring,JOA score before treatment.Six independent variables were substituted into the two-class logistic regression model for multivariate analysis..Multivariate logistic regression analysis showed that the effects of total JOA score and supine turn-scoring before treatment on the efficacy of patients were statistically significant(P<0.05).There are many factors influencing the efficacy of traditional Chinese medicine treatment of DLS,and the probability of obtaining a significant effect for each additional point of JOA score and supine turn-score before treatment increases by 1.167 and 0.410 times,respectively.Conclusion:The clinical application of lumbar spine reduction combined with lumbar rehabilitation exercises in patients with degenerative lumbar spondylolisthesis with a higher total JOA score or a lower limit of supine turning can achieve better clinical results.This finding has certain guiding significance for the clinical application of this therapy in the treatment of DLS,and is beneficial to improving patient satisfaction and clinical effectiveness.

Treatment of Single Level Lumbar Spondylolisthesis with Lumbar Interbody Fusion via Oblique Lateral Approach (OLIF)

Objectives: To investigate the effect of lumbar interbody fusion via the oblique lateral approach (OLIF) in the treatment of single level lumbar spondylolisthesis. Methods: Retrospective analysis was made on 32 cases of single level lumbar spondylolisthesis treated by lumbar interbody fusion via the oblique lateral approach from July 2020 to July 2021. 14 males and 18 females;the age was (66.5 ± 11.5) years (55 - 82 years). 1) The operation time, intraoperative blood loss and complications were recorded;2) the scores of visual analog scale. VAS and Oswestry disability index (ODI) of low back pain and lower limb pain were collected before operation and at the last follow-up;by observing the imaging data, the height of the intervertebral space, the anterior convex angle of the intervertebral space, the anterior convex angle of the lumbar spine, the sagittal diameter of the dural sac and the spondylolisthesis were measured. Results: All patients successfully completed the operation, the average operation time was (103.9 ± 21.1) min, the average intraoperative bleeding volume was (72.3 ± 16.4) ml. There was no vascular injury during the operation, no infection occurred in all surgical incisions, and Class I/A healing was achieved. The VAS scores of low back pain and leg pain before operation and at the last follow-up were lower than those before operation, and the difference was statistically significant (P < 0.05);the ODI at the last follow-up was lower than that before operation, and the difference was statistically significant (P < 0.05). At the last follow-up, the height of intervertebral space, the height of intervertebral foramen and the sagittal diameter of dural sac were greater than those before operation, with statistically significant differences (P < 0.05);the spondylolisthesis rate at the last follow-up was lower than that before operation, with a statistically significant difference (P < 0.05). Left thigh surface numbness occurred in 2 cases (6.3%) and disappeared after 1 week;Hip flexion weakness occurred in 1 case (0.03%), which recovered after 12 days;there were no complications such as retroperitoneal hematoma, ureteral injury, retrograde ejaculation, intestinal and lumbar plexus injury. Conclusion: The early clinical effect of OLIF in the treatment of single level lumbar spondylolisthesis is significant. This surgical method is minimally invasive, safe and effective, which can significantly reduce the amount of intraoperative bleeding and reduce the risk of postoperative complications. Its main working principle is to make the annulus fibrosus, posterior longitudinal ligament and ligamentum flavum shrink and recover the height of the intervertebral space through decompression, loosening and stretching of the intervertebral space, so as to achieve the reduction of the slipped vertebral body, increase the height of the intervertebral foramen Enlarge the spinal canal volume and eliminate dynamic compression to play an indirect decompression role, improve the symptoms of low back and leg pain, and reconstruct the stability of the spine through interbody fusion.

Manipulation for degenerative lumbar spondylolisthesis:A systematic review of randomized controlled trials

Objective: To assess the effectiveness and safety of manipulation intervention for degenerative lumbar spondylolisthesis(DLS).Methods: This is a systematic review and meta-analysis. A full-scale retrieval method was performed until February 1, 2021, including nine databases. The homogeneity of different studies was summarized using the Review Manager. The quality of studies was determined with the Cochrane risk-of-bias tool.The evidence quality was graded with the Grading of Recommendations, Assessment, Development, and Evaluations approach.Results: A total of 6 studies involving 524 participants were included. The review demonstrated that manipulation has statistically significant improvements for treating DLS according to Japanese Orthopedic Association scores(mean difference, 3.76;95% confidence interval, 2.63 to 4.90;P <.001) and visual analog scale scores(mean difference,-1.50;95% confidence interval,-1.66 to-1.33;P <.001)compared to the control group. One study reported that the difference in the Oswestry Disability Index between the traction group and the combination of manipulation and traction group was statistically significant(P <.05), while another reported that manipulation treatment can significantly improve the lumbar spine rotation angle on X-ray images compared with the baseline data(P <.05). Moreover, the manipulation group(experimental group) had fewer adverse events than the lumbar traction group(control group).Conclusion: Manipulation intervention is more effective and safer for DLS. Nevertheless, large-scale randomized controlled trials are required to confirm the current conclusions.

Isthmic spondylolisthesis: Interpretation of NASS guidelines for evidence-based medicine

Isthmic spondylolisthesis in adults is a common clinical disease that causes lower back pain. In order to provide the best and effective diagnosis and treatment plan, in 2014, the North American Spine Association (NASS) formulated the guidelines for the diagnosis and treatment of isthmic spondylolisthesis in adult (hereinafter referred to as the guideline). Through the systematic review of literature, evidence-based medical evidence analysis was conducted to identify different recommended intensities, to discuss the clinical diagnosis and treatment plan mainly from two aspects of diagnosis and treatment. This article gives a brief explanation of the guidelines and discusses them in combination with the clinical practice in China, so as to provide a reference for clinicians.