Clinical Comparison Of Three Operative Methods In The Treatment On Senile Degenerative Spondylolisthesis

Background: Degenerative lumbar spondylolisthesis is defined as a long time of continuing instability in lumbar spine which makes the degeneration of corresponding facet joint, flatten of the facet joint, and adding on disc degeneration, then leads to the relaxation and unsteadiness of the intravertebral body, then gradually cause the lumbar interbody displaces partly or totally. As the aging of Chinese population, the incidence of degenerative lumbar spondylolisthesis increase rapid. It has become a common reason for lumbar back pain in the elderly with serious impact on quality of life. By the influence of the traditional concept and economic factors, the elderly patients reluctance to accept surgical treatment. After long and repeated conservative treatment the symptoms cannot be released. The patients who forced to accept the surgery are mainly older and weaker, with severe spinal degeneration, complicated pathological changes, poor general condition, less tolerance of surgery and high risk of surgical treatment. So for a long time there are disputes in understanding the surgery operation indication and choosing the surgical methods, integration and the fixing ways for the senile degenerative spondylolisthesis. In recent years, many scholars at home and abroad for senile degenerative spondylolisthesis treatment of new ideas, surgery and surgical technology program, but individual cases for appropriate treatment options are still urgent problems now.Objective: The purpose of this study (1)Clinical comparison of three operation methods in the treatment on senile degenerative spondylolisthesist;(2)adaptation the surgery operation indication, surgical approach selection, integration and fixed as well as perioperative and so on. Method: One hundrad and sixteen patients are all selected in the second clinical hospital of Jilin University during in September 2000 to March 2007 treated by routine orthopedic surgical treatment with degenerative lumbar spondylolisthesis, and divided into three groups according to different surgical methods. Group A:laminectomy fenestration decompression,Transverse Process fusion; Group B: laminectomy decompression, interbody fusion; Group C: laminectomy decompression, interbody fusion devices (Cage) fusion, vertebral pedicle screw-rod fixation system. Follow-up of pro-&post-surgery and final is scored by Orthopaedic Association of Japan (Japanese Orthopaedic Association, JOA) score of low back pain and calculation of the fine rate. Then we contrasted pro-and post- lumbar spine surgery's positive ,lateral,hyperextensive X ray imaging and mastered the pre- and post- operative and final follow-up of the intervertebral space height, the percentage of spondylolisthesis, the changes of lumbar interbody degrees and fusion rate. Result: (1) JOA score: three groups of patients has markedly improved (P<0.01) compared with the preoperative scores, the early efficacy is significantly. Final follow-up of Group A's JOA score and postoperative JOA score comparison(P<0.05) show there is significant difference on the final follow-up of patients with symptoms recrudesce, long-term effect as early efficacy; final follow-up of Group B's JOA scores and postoperative JOA score comparison(P> 0.05)shows no significant difference on the final follow-up of Group B with symptoms no recrudesce, efficacy remained stable; Final follow-up of Group C's JOA scores and postoperative JOA scores comparison(P <0.05)shows there is significant difference on follow-up of patients with symptoms eventually after further improvement in satisfaction with long-term efficacy. A, B, C three groups of inter-group comparison, by the homogeneity of variance test, preoperative JOA score was no significant difference (P = 0.89> 0.05), postoperative JOA score was no significant difference (P = 0.527> 0.05), follow-up JOA score finally there is significant difference (P = 0.000 <0.05), note C group trip laminectomy, fusion devices (Cage) fusion, pedicle screw-rod fixation system of long-term effect of than the first two of the better technique. (2) C group eventually follow-up x-ray film of all cases reached the bony fusion rate was 100%, no broken nails, broken rods, the vertebral height significantly more preoperative Recovery, intervertebral activity than preoperatively significantly reduced; Group B final follow-up x-ray films showed bony fusion rate was 75%, postoperative vertebral height than preoperative Recovery, intervertebral activity than preoperative reduced, but in the end follow-up decreased vertebral height, vertebral between the degree of activity has increased; A group eventually follow-up x-ray films showed bony fusion rate was 46.9%, the final follow-up of vertebral height decreased, the percentage has increased spondylolisthesis, lumbar interbody activity has changed Great. Finally follow-up group C intervertebral space height, the percentage of spondylolisthesis, lumbar interbody activity, the fusion rate measured values are well in the A group and B group. However, C group at the operative time, amount of bleeding and surgical costs than A group and B group spent many, adjacent segment degeneration than the A group and B group weight. Conclusion:(1)many of the pathogenic factors may lead to senile degenerative lumbar spondylolisthesis, the illness and physical status of patients is different, grasp surgery operation indication at preoperative surgical, combined with signs and symptoms and imaging information on a comprehensive study to consider, formulate a good program of individualized surgery; (2) by Posterior laminectomy,interbody fusion,pedicle screw rod system fixation in the treatment of degenerative lumbar spondylolisthesis elderly, postoperative improvement rate, fusion rate, after more good, satisfactory, but the trauma of the surgery in c is larger , the expenditure of the surgery in c is higher and increasing the neighboring segment degeneration; (3) laminectomy fenestration decompression transverse process fusion and laminectomy decompression, interbody fusion,less surgical time,less trauma,less bleeding,fewer complications,the cost is low,early can be very good mitigation the elderly patients with degenerative lumbar spondylolisthesis clinical symptoms, but long-term efficacy than laminectomy interbody fusion pedicle screw rod system fixation.