Bilateral Draw-back Reduction With Percutaneous Pedical Screw Combining MIS-LIF For Spodylolisthesis

Objective:To explore the technical skills and assess the clinical outcomes of bilateral drawback reduction using percutaneous pedical screw with MIS-LIF in the treatment of lumbar spodylolisthesis.Methods:From 2013 to 2016,27 patients with symptomatic spondylolisthesis were underwent bilateral draw-back reduction using percutaneous pedical screw and MISLIF,which include 10 males and 17 femals,with the age from 40 to 83years(average,61 years).All the 27 cases were single level disease,including 11 cases of lumber degenerative spondylolisthesis and 16 cases of lumbar isthmic spondylolisthesis.Spondylolisthesis occurred at L3 in 2 patients,at L4 in 15 patients,and at L5 in 10 patients.According to Meyerding classification,there were 16 cases in grade Ⅰ,10 in grade Ⅱ and 1 in grade Ⅲ.The operation time,blood loss,postoperation duration of hospital stays and complication were recorded.The clinical effects were accessed by visual analogue scale(VAS)and Oswestry disability index(ODI).The reduction effects of slippage were estimated by comparing post-operation spondylolisthesis rate and intervertebral height to pre-operation.Evaluate intervertebral fusion situation was evaluated according to SUK standard.Results:The operative time was 203.9±34.9 minutes.The intra-operative blood loss was 206.7±39.9 ml.There is no blood transfusion during perioperation.Postoperative hospital stay was 8.1±1.3 days.TheVAS of back and/or leg pain was decreased from 7.2±0.6 in preoparation to2.3±0.9 in postoperation(P=0.00)while the ODI was declined from preoperative 62.8±6.8 to33.5±4.1at three months after operation(P=0.00).The slip percentage was changed frompreoperative 26.5±15.0% to postoperative 3.1±6.1%,accordingly the reduction percentage of spondylolisthesiswas 91.0±16.5%.Meanwhile,the disc space height index wasincreased from31.5±9.6%in preoparation to43.8±7.1% in postoperation(P=0.00).The rate of lumbar interbody fusion was definitely 29.6% and possibly 51.9%,one year after operation.No nerve roots and cauda equina injuries occurred during the operation.No extraction of screws and cages,or break of screws and rods,were found during the follow-up period.Conclusion:Bilateral draw-back reduction using percutaneous pedical screw with MIS-LIF for symptomatic spondylolisthesis appears to be an safe,effective and minimally invasive surgical option.