Clinical Comparison Of Two Operative Methods In The Surgical Treatment On Ⅰ,Ⅱ Degree Degenerative Lumbar Spondylolisthesis

Background: Along with social development, scientific and technological progress, the level of medical technology raise, people have deepen understanding of degenerative spondylolisthesis. More and more patients received surgical treatment,and get a good effect, their quality of life also have improved . With depth study of spine surgery in biomechanics, internal fixation equipment, integration technique, and new treatment ideas, surgery program, surgical techniques are presented, there are many problems to solve.Select the appropriate treatment is still a problem in surgical treatment of spinal.Objective:(1) Using two different surgical treatment to cure degenerative lumbar spondylolisthesis, and then evaluated the treatment and analyzed the imageology results;(2)Choose the method of surgical procedure, fusion and fixation.Method: Reviewed 52 patients with degenerative spondylolisthesis who underwent surgical treatment in department of Orthopaedics of the Second Hospital of Jilin University in August 2005 -2009. It were divided into two groups according to different surgical procedures, Group A: posterior decompression and pedicle screw fixation in situ transverse process bone grafting; Group B: Spinal pedicle screw fixation and interbody fusion. Using the efficacy of low back pain score of Japanese Orthopaedic Association to analyze the efficacy and statistics the quality rate before and after operation. Compared of imageology changes before and after surgery.Understanding the disc height, the activity of vertebral body and the fusion rate in preoperative, postoperative and final follow-up.Result:â‘ The JOA score of Group A in preoperative and postoperative had significant statistical difference (P <0.01), showed that the surgical procedures can relieve early postoperative clinical symptoms and significant effect. Compared of the JOA score of postoperative and the final follow-up, there was no statistical significance (P> 0.05), showed that the final follow-up in patients with no recurrence of symptoms, and it able to maintain long-term efficacy.The JOA score of Group B in preoperative and postoperative had significant statistical difference (P <0.01), showed that the surgical procedures can relieve early postoperative clinical symptoms and significant effect.Compared of the JOA score of postoperative and the final follow-up, there was significant statistical significance (P< 0.05), showed that the symptoms have been further improved in the final follow-up,satisfactory long-term effects. The JOA score in preoperative and postoperative had significant statistical difference between Group A and Group B (P >0.05).The JOA score of the final follow-up has statistically significant (P <0.05), showed that the long-term results of Group B was better than Group A .â‘¡The lateral X-ray showed that all patients achieved bony fusion standards, fusion rate was 100%, within the plant without loosening, broken case, disc height recovery, slippage in anatomic reduction in the final follow-up of Group B.The disc height had no change in the final follow-up. The lateral X-ray showed the bony fusion rate was 75%, the disc height had restoration, the acivity of interbody was reduced,but the disc height decreased, and there was collapse in intervertebral space,and the activity between vertebral body was not increased significantly in final follow-up of Group A . The X-ray films showed bony fusion rate was 86.95%, disc space height had no significant changes,the disc height decreased slightly in final follow-up of Group A. The disc space height and the fusion rate measurements were better than Group A in final follow-up of Group B. However, the mean operation time, average blood loss and surgical complications of Group B were more than Group A.Conclusion: (1)The factors of degenerative spondylolisthesis are complex because patient age, disease and physical conditions are different. We should be strictly controlled preoperative surgical indications, contraindications, consideration of clinical symptoms and imaging data to change the comprehensive , making individual surgical plan; (2) Spinal pedicle screw fixation and fusion for treatment of degenerative intervertebral lumbar spondylolisthesis, the immediate postoperative recovery lumbar stability, the improvement rate and fusion rate are good, it can provide satisfactory results after early and long-term therapy.But it has the disadvantages of great trauma, hemorrhage, complications and others; (3)The blood loss and complications are relatively few with posterior decompression and pedicle screw fixation in situ transverse process fusion,and it can relief the clinical symptoms of patients with degenerative lumbar, but the long-term efficacy and fusion rates are lower than laminectomy and pedicle screw fixation and interbody bone fusion operation.