Vol. 10, Issue 4 (2024)
Short term outcomes of PLIF with cage & bone graft for the management of adult isthmic spondylolisthesis
Dr. KM Rafiqul Islam, Dr. Sharmin Chowdhury, Dr. Ahsan Majid, Dr. Md. Moshiur Rahman, Dr. Md. Alinoor, Dr. Md. Shamsul Alam, Dr. Ramzanul Karim Khan, Dr. Md. Ibrahim Miah, Dr. Motiur Rahman and Dr. Md. Anowarul Islam
Background: There are different surgical procedures have been recommended for the treatment of Adult Isthmic Spondylolisthesis, but controversy still exists regarding the optimal surgical technique. In this study, we observed the Clinical, Radiological and Functional outcomes of posterior lumbar interbody fusion (PLIF) with cage & autogenous cancellous bone graft with pedicle screw fixation in the treatment of Adult Isthmic Spondylolisthesis.
Objectives: To evaluate the safety and efficacy of PLIF with cage & bone graft for the treatment of Adult Isthmic Spondylolisthesis
Method and Materials: This Prospective Interventional Study was conducted in the Department of Orthopaedics Surgery, BSMMU & other & private hospitals of Dhaka from March 2022 to May 2023. From this study 13 patients who underwent PLIF with cage & bone graft after meeting inclusion criteria will be included in the study. Assessment will be done preoperatively, immediate postoperatively and after 1 month, 3 months, 6 months and 12 months. Evaluation will be performed by clinical examination and radiology. Functional Outcome will be assessed by Visual Analog Scale (VAS) score and Oswestry Disability Index (ODI), along with overall outcome by Modified Macnab’s criteria; and fusion rate by Bridwell criteria.
Results: A total of 13 patients with AIS were included, among whom 8 (61.5%) were female and 5 (38.5%) were male, with a female- male ratio of 1.60:1 The mean age of the study population was 55.46±8.599 years, and the maximum number of patients were between the 60-69 years age group (46.6%). The maximum (61.50%) of patients were housewives, followed by sedentary workers (23.1%) and manual workers (15.4%). According to Meyerding grading, 69.2 percent had grade II, and 30.8 percent had grade III spondylolisthesis in the preoperative x-ray. All found a significant reduction in postoperative radiology. Preoperatively Low back pain and neurogenic claudication were present in all patients. Radiculopathy was found in 12 (92.30%) of the study population; among them, unilateral radiculopathy was present in 5 (42%) and bilateral radiculopathy in 7 (58.0%) patients. Sensory impairment in 12 (92%) cases before operation and motor involvement in 10 (77%) cases, all became intact after the operation. VAS for back pain and leg pain was improved significantly from preoperative 7.23±1.16 and 6.38±2.06 respectively, to postoperatively at final follow-up 0.85±0.80 and 0.77±0.59, respectively. Preoperative ODI was improved significantly from 69.23±7.86 to postoperatively at final follow-up 8.46±2.22. In most of the cases, 8 (61.54%) were fused, and 5 (38.46%) were probably fused after 15 months of operation according to the radiological assessment of fusion according to Hackenberge ctriteria, CT scan was carried out in 5 probably fused cases, where 4 out of 5 (80%) cases were fused, and 1 out of 5 (20%) case was fragmented considering Cristensen assessment scale for CT.
Conclusion: It can be concluded that posterior lumbar interbody fusion (PLIF) by Banana cage with bone graft can be a very good option for the treatment of high-grade lumbar spondylolisthesis at L5-S1 levels.
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