Clinical Study On Treatment Of Degenerative Lumbar Spondylolisthesis With Sitting Lumbar Rotation Reduction

Objective:To observe the epidemiological characteristics of degenerative lumbar spondylolisthesis.To study the clinical efficacy of lumbar rotation reduction manipulation in sitting position. To investigate the operation specification of the sitting lumbar rotation reduction manipulation and to promote its application on clinic.To provide effective reference for the establishment of the treatment and rehabilitation integration scheme of degenerative lumbar spondylolisthesis.Method:Applying the method of large sample,multicenter and randomized controlled trial,we divided 535 cases of degenerative lumbar spondylolisthesis patients randomly in two groups,with 267cases in the test group and the other 268 cases in the control group.The test group is treated by sitting lumbar rotation reduction manipulation and lumbar rehabilitation exercise,while the control group is treated by supine lumbar traction and waistline brake method,with each treatment for 3 weeks.On the day of case screening and enrollment、treatment period and 3 times follow-up totally 12 viewpoints we observe and record the curative effect evaluation standards of disease related to low back pain and the VAS score.At least, we analyze and evaluate the data by using the SAS statistical software.Results:(1) In all the cases there were 128 male patients,accounting for 24.15%,402 female patients,accounting for 75.85%,showing that female incidence is much higher than male.In terms of age,161 patients were 56-60 years old,accounting for 30.7% and 150 patients are 61～65 years old,accounting for 28.6%. that’s to say,this disease is most common among age of 56～65 years old. Among them, there were 317 cases with L4 spondylolisthesis,accounting for 60.2%; 108 cases with L3 spondylolisthesis,accounting for 20.5%;83 cases with L5 spondylolisthesis,accounting for 15.7%.That’s to say L4 spondylolisthesis is most common.In the direction of spondylolisthesis, there were 451 cases with slipping forward,accounting for 86.1%,73 cases with slipping backword,accounting for 13.9%.Obviously,slipping forward is most common on clinic.In terms of course,211 patients were in 1 year or less,accounting for 39.9%,220 patients are in 1-5 years,accounting for 41.6%,showing that 0-5 years is most common on clinic.(2)At the end of treatment,74 cases were clinically controlled,18 cases were markedly effective,83 cases were effective and 87 cases were ineffective in 262 patients of the study group,and the total efficiency is 66.79%,the effective rate is 35.11%.In the control group,73 cases were clinically controlled,17 cases were markedly effective,51 cases were effective,124 cases were ineffective,as the total efficiency is 53.21%,and the effective rate is 33.97%.Through rank sum test,there is significant statical significance.That’s to say, sitting lumbar rotation reduction is obviously better than the lumbar traction therapy in the treatment of degenerative lumbar spondylolisthesis. (3)The comparision of JOA score between the two groups at the end of treatmengt and the 6th month follow-up,though t test,both was significantly statistical different(P<0.01).It proves that the sitting lumbar rotation reduction combined with lumbar rehabilitation exercise is significantly superior to the lumbar traction therapy combined with waistline brake in improving patients with symptoms and signs.And both the short-term and medium-term curative effect is stable.(4)In the VAS score improvement,there were differences from the 5th visit,by t test, P<0.01,with significant statistical significance,proving that the pain improvement of the test group is better than the control group in around 10days.In the analysis of the VAS score minus baseline,there was significant statiscal difference between the two groups from 2th visit to 9th visit(P<0.05).And the difference also existed in the 3 follow-up visits (P<0.001),confirming the short and medium term efficacy of the sitting lumbar rotation reduction combined with lumbar rehabilitation treatment.Conclusion:(1) Degenerative lumbar spondylolisthesisis most common in middle-elderly population,especially in age of 55-65 years old;female incidence is much higher than male;L4 spondylolisthesis is the most common,followed by L3,L5 seperately;slipping forward is the main direction;duration of 0-5 years is most common in the course of the disease.(2) The sitting lumbar rotation reduction combined with lumbar rehabilitation is significantly better in the treatment of degenerative lumbar spondylolisthesis than that of the lumbar traction combined with waistline brake,no matter in the end of treatment or the in the 6th month follow-up.And the short and medium term efficacy is stable. (3) The sitting lumbar rotation reduction manipulation combined with lumbar rehabilitation exercise can significantly improve the patients with clinical symptoms and signs(JOA scores).