The Study Of Distance Changes Between Preemptive Nail Position Of Lumbar Pedicle Screw And Anterior Large Vessels In Patients With Lumbar Spondylolisthesis

Objective:This paper was a anatomical radiographic study of distances between the preemptive nail position of lumbar pedicle screw and lumbar intervertebral disc and anterior large vessels in patients with lumbar spondylolisthesis,and to provide clinical basis for evaluating the safety of pedicle screw implantation and disc removal during lumbar spondylolisthesis.Methods:Complete computed tomography(CT)data of 104 patients with grade I lumbar spondylolisthesis(L4 52 and L5 52)and 107 patients with non spondylolisthesis(control group)were enrolled in this study.The distances between preemptive nail position of lumbar pedicle screw and lumbar intervertebral disc and anterior large vessels(abdominal aorta,inferior vena cava,left and right common iliac artery,internal and external iliac artery)were respectively measured and analyzed by SPSS(v25.0).Results:1.In non spondylolisthesis patients,the distance between the right preemptive nail position of lumbar pedicle screw and anterior large vessels in the L4 and L5 vertebral body was less than the left side(P<0.05),while there was no significant difference in the S1 vertebral body(P>0.05).2.In non spondylolisthesis patients,the distance between the right preemptive nail position of lumbar pedicle screw and anterior large vessels in the L4-5 intervertebral disc was less than the left side(P<0.05),while there was no significant difference in the L5-S1 intervertebral disc(P>0.05).3.In lumbar 4 spondylolisthesis patients,the distance between the right preemptive nail position of lumbar pedicle screw and anterior large vessels in the L4,L5 vertebral body and L4-5 intervertebral disc was less than the left side(P<0.05).4.In lumbar 5 spondylolisthesis patients,the distance between the right preemptive nail position of lumbar pedicle screw and anterior large vessels in the L5 vertebral body was less than the left side(P<0.05),while there was no significant difference in the S1 vertebral body and L5-S1 intervertebral disc(P>0.05).5.No correlation was found between lumbar lordosis and the distance between preemptive nail position of lumbar pedicle screw and anterior large vessels in both non spondylolisthesis and spondylolisthesis patients.Conclusion:1.Both in non spondylolisthesis and spondylolisthesis patients,placing pedicle screw on the right side of the L4 and L5 vertebral body is more dangerous than placing it on the left side.2.Both in non spondylolisthesis and spondylolisthesis patients,performing the surgery at the right side of L4-5 disc increases a patient’s risk of large vessel injury,compared with that at the left side,but there was no significant difference in L5-S1.3.During placing pedicle screw in the L4 and L5 vertebral body and removing L4-5 intervertebral disc,patients with lumbar 4 spondylolisthesis bear less risk of large vessel injury than the non spondylolisthesis patients.4.During placing pedicle screw in the L5 vertebral body,patients with lumbar 5 spondylolisthesis bear less risk of large vessel injury than the non spondylolisthesis patients,but there was no significant difference in S1 and L5-S1.5.Lumbar lordosis does not affect the measurement of distance between preemptive nail position of lumbar pedicle screw and anterior large vessels.