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Spine Fusion for Spondylolisthesis Studied
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Posted on: 11/30/2003
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Some back problems are easier to treat than others. Take, for example, a simple muscle strain. Treatment is simple: rest, ice, and anti-inflammatory drugs followed by some stretching. Problems such as a disc injury may take more time and more treatment.
One of the most challenging spine conditions is called spondylolisthesis. This is actually a "slipped vertebra." The main body of the vertebra slips forward over the disc and vertebral body below it. When this happens, the affected spinal segment becomes unstable. The disc may get pressed, and the spinal nerves can get pinched. Surgery may be needed. But it's not really that simple. Every case is different depending on how much the vertebra has slipped, the patient's age, and how much the disc has changed with age.
Most studies agree that the spine must be fused from the front (anterior) and the back (posterior). A single fusion just isn't as good as a combined fusion. Here again, the decision isn't simple. There are different ways to perform anterior and posterior spinal fusion. In this study, the results of a transforaminal lumbar interbody fusion (TLIF) were studied.
TLIF is done from the side of the spine instead of from the front or back. The surgeon works through an opening on the side of the vertebra to remove the disc. The opening is also used to insert bone graft and a special cage into the disc space. Screws are hold the bones in place until the graft takes hold.
X-rays were taken before surgery, right after surgery, and three to 12 months later. The X-rays were used to look at the disc height, correction of the bones, and position of the cage. The X-rays showed an increase in disc height at first. Then there was a gradual loss of disc height over time.
The forward slip of the vertebra wasn't changed much. The authors think this is because there isn't adequate room to put the cage forward far enough to change the angle. They suggest smaller cages might work better. The cage needs to be placed as far forward as possible in the disc space. This study showed that spondylolisthesis can be treated successfully with TLIF.
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References:
Brian K. Kwon, et al. Radiographic Analysis of Transforaminal Lumbar Interbody Fusion for the Treatment of Adult Isthmic Spondylolisthesis. In Journal of Spinal Disorders. October 2003. Vol. 16. No. 5. Pp. 469-476.
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