A Clinical Controlled Study Of Vertebral Arch Replantation And Laminectomy In Mild To Moderate Isthmic Spondylolisthesis

Objective:To compare the clinical effect of vertebral arch replantation and laminectomy in the treatment of single segment mild to moderate spondylolytic spondylolisthesis.Methods:The surgical data of 66 patients with isthmic spondylolisthesis were retrospectively analyzed.The patients were divided into two groups according to the operation method.The experimental group was vertebral arch replantation in 34 cases(n=34),and the control group was laminectomy(n=32).The two groups underwent intervertebral fusion.The postoperative clinical evaluation of the two groups,the preoperative and postoperative VAS score,JOA score,ODI index,the fusion rate of the vertebral arch in the experimental group and the epidural scar formation in the control group were counted..The lumbar positive lateral radiograph,lumbar CT three-dimensional reconstruction,and lumbar spine MRI were reviewed every 3 months after surgery.Results:All patients successfully completed the operation without any complications such as aggravation of nerve injury,dural tear or infection.There was no statistically significant difference in the operative time between the experimental group and the control group(t=0.583,P=0.562),but the intraoperative blood loss was significantly lower than that of the control group(t=2.134,P=0.037).All 66 patients were followed up for 13 to 18 months,with an average of 16.2 months.Postoperative clinical symptoms of all patients were significantly improved.In the control group,7 patients were found to have symptoms of spinal canal stenosis with postoperative posture changes at 3 months after surgery,which could be relieved at rest,then the symptoms gradually disappeared,and 5patients showed mild lower limb numbness at 18 months after surgery.No complications such as infection,nerve injury or dural tear occurred in other patients.At the last follow-up,the fusion rate of intervertebral bone grafting and vertebral arch replantation in the experimental group was 100%,and that of the control group was also 100%.VAS,ODI and JOA scores were significantly improved at each time point after surgery(P<0.01).ODI score and JOA score of the experimental group were significantly betterthan those of the control group at 3 months after surgery and at the last follow-up(P<0.05),and the difference in scores between the two groups at other time points was not statistically significant(P>0.05).According to the standard proposed by hou shuxun,the excellent and good rate was 91% in the experimental group and 84% in the control group.The difference was statistically significant(2=1.092,P=0.573).In the experimental group,34 cases of epidural scar tissue were completely blocked outside the replantation vertebral arch,while in the control group,11 cases of 32 cases of epidural scar tissue invaded the spinal canal.Conclusion:Two kinds of operation method in the treatment of mild-to-moderate(Meyerding slippage grading I °,II °)spondylolysis of lumbar olisthe disease in all can achieve good clinical effect,and implant but vertebral arch and vertebral lamina excision,better able to improve the postoperative neurologic symptoms,and rebuild the bony vertebral canal to the greatest extent,restore the spinal canal environmental stability,prevent epidural scar tissue of nerve tissue invasion,for lumbar spondylolysis sex slippage is a good operation method.