Correlation Between The Effect Of Lumbar Spondylolisthesis And The Degeneration Of Adjacent Segments

Objective: To analyze whether there is a correlation between the degree of reduction and the parameters of the adjacent segment and the occurrence of ASD(adjacent segment degeneration)in cases of lumbar spondylolisthesis.Methods: Data from patients with degenerative lumbar spondylolisthesis or spondylolysis spondylolisthesis treated with posterior decompression and internal fixation(PLIF or TLIF)in our hospital from 2012 to 2017 were collected,including age and sex,preoperative complications,preoperative gliding grade,surgical segment,spondylolisthesis,surgical methods,and reduction degree.The standard lumbar lateral radiographs were obtained before and after surgery and at the last follow-up for lumbar spondylolisthesis.Respectively measured the following parameters:(1)slippage segment: vertebral slip degree,intervertebral angle,vertebral body tilt angle,height of the intervertebral disc(2)Proximal adjacent segment: vertebral slip degree,slip angle,height of the intervertebral disc:(3)Remote adjacent segment:slip degree,slip angle,height of the intervertebral disc(if there is no slip before the adjacent segment,it is 0 mm.Positive value of vertebral body movement,backward migration Negative value: Lumbar lordosis intervertebral angle is recorded as positive value,lumbar kyphosis is recorded as negative value,and the upper edge of the vertebral body is slanted forward and down the positive value,and negative value is recorded afterwards.The spondylolisthesis is L4 vertebral spondylolisthesis.The L5 / S1 gap related parameters also need to be measured).To analyze the degree of lumbar spondylolisthesis in patients with different degrees of lumbar spondylolisthesis,whether the degree of slip,slip angle,and height of the intervertebral disc were restored were related to the occurrence of adjacent segment-related parameters and ASD(adjacent segment degeneration).Results:According to the inclusion and exclusion criteria,a total of 99 cases of lumbar spondylolisthesis were collected and 24 males(24.24%)were included in the complete imaging data,and 75 females(75.76%)were female.The ratio of male to female was approximately 1:3,and the average age was 52.81.±8.52 years old.Thefollow-up time ranged from 12 to 50 months and the average follow-up time was20.7±8.8 months.Among them,64 patients with degenerative lumbar spondylolisthesis and 35 patients with Isthmic spondylolisthesis.Slip-segment segment L3 6(6.1%)cases,L4 55(55.6%)cases,L5 38(38.4%)cases,indicating the method of PLIF 70 cases,TLIF group of 19 cases.Preoperative vertebral vertebral grading: 50 cases in degree I,48 cases in degree II,and 1 case in degree III: 58 cases in single-segment fixation group,36 cases in double-segment fixation group,and 5cases in three-segment fixation group Immediately after the reset level:.Partially repositioned in 50 cases,complete reposition in 49 cases in which 14 cases occurred adjacent postoperative degeneration,non-ASD group in 85 cases,adjacent segment degeneration rate was approximately 14.14%.ASD group and non-ASD group gender,preoperative merger Symptoms,lumbar spondylo-listhesis segment,preoperative lumbar spondylolisthesis grade,spondylolisthesis classification,surgical approach,and reduction degree were all not statistically different(P> 0.05),and grouped by year(P = 0.009,OR = 0.085,95% CI = 0.013-0.544.Immediately after the operation,the height of height of the intervertebral disc was slipped(P = 0.005,OR = 1.549,95% CI = 1.142-2.102),and the vertebral slip angle slipped immediately after surgery(P = 0.018,OR = 1.306,95).%CI = 1.047-1.629)and operative segments(P = 0.012,OR = 0.022,95% CI = 0.001-0.432)were independent risk factors for ASD after fusion in lumbar spondylolisthesis patients.Conclusion: The patients with spondylolisthesis have excessive expansion of height of the intervertebral disc and lack of recovery of the slip angle.The age and the surgical segment are closely related to the postoperative ASD.It is a risk factor for postoperative ASD.There is no correlation between the degree of reduction and the occurrence of ASD.Therefore,It is not necessary to pursue excessive anatomical reduction during surgery,the operator should pay attention to the postoperative patient’s surgery.Normal height of the intervertebral disc and slip angle,try to avoid the fixation of long segments,reasonable treatment arrangements for elderly patients.