12
Volume 04 Issue 02-2022
The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN
–
2689-1026)
VOLUME
04
I
SSUE
02
Pages:
12-16
SJIF
I
MPACT
FACTOR
(2020:
5.
286
)
(2021:
5.
64
)
OCLC
–
1121105510
METADATA
IF
–
7.569
Publisher:
The USA Journals
ABSTRACT
Spondylolisthesis occurs in 3-4% of the population and causes lumbosacral pain in 8-10% of cases. Spondylolisthesis can
be caused by degenerative changes in the intervertebral disc and vertebral joints (degenerative spondylolisthesis) or
by a defect in the joints that usually connect the vertebrae together. This defect can be congenital, i.e. based on
spondylolysis (true spondylolisthesis) or develop as a result of trauma (posttraumatic spondylolisthesis). Lumbar
spondylolisthesis is one of the most severe forms of spinal pathology.
KEYWORDS
Vertebrae, joints, Spondylolisthesis, spondylolysis.
Research Article
OPTIMAL CHOICE OF SURGICAL TREATMENT FOR LUMBAR
SPONDYLOLISTHESI
Submission Date:
February 10, 2022,
Accepted Date:
February 20, 2022,
Published Date:
February 28, 2022 |
Crossref doi:
https://doi.org/10.37547/TAJMSPR/Volume04Issue02-04
Tilyakov Aziz Burievich
Samarkand State Medical Institute, course of traumatology and orthopedics of DKTF Samarkand branch of
the Republican Specialized Scientific and Practical Medical Center of Traumatology and Orthopedics,
Uzbekistan
Pardaev Saidkosim Norkulovich
Samarkand State Medical Institute, course of traumatology and orthopedics of DKTF Samarkand branch of
the Republican Specialized Scientific and Practical Medical Center of Traumatology and Orthopedics,
Uzbekistan
Nazarov Sarboz Parda ugli
Samarkand State Medical Institute, course of traumatology and orthopedics of DKTF Samarkand branch of
the Republican Specialized Scientific and Practical Medical Center of Traumatology and Orthopedics,
Uzbekistan
Tilyakov Hasan Azizovich
Samarkand State Medical Institute, course of traumatology and orthopedics of DKTF Samarkand branch of
the Republican Specialized Scientific and Practical Medical Center of Traumatology and Orthopedics,
Uzbekistan
Journal
Website:
https://theamericanjou
rnals.com/index.php/ta
jmspr
Copyright:
Original
content from this work
may be used under the
terms of the creative
commons
attributes
4.0 licence.
13
Volume 04 Issue 02-2022
The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN
–
2689-1026)
VOLUME
04
I
SSUE
02
Pages:
12-16
SJIF
I
MPACT
FACTOR
(2020:
5.
286
)
(2021:
5.
64
)
OCLC
–
1121105510
METADATA
IF
–
7.569
Publisher:
The USA Journals
INTRODUCTION
Purpose of the study
: Choice of the optimal method
for surgical treatment of lumbar spondylolisthesis.
Material and methods
. Clinical observations of
patients operated on at the spine injury department of
the
Republican
Scientific-Practical
Center
of
Traumatology and Orthopedics in Samarkand served
as the material for the study. However, two-level
lumbar spondylolysis and spondylolisthesis are rare.
We studied 24 cases with this pathology. Of the
patients with spondylolisthesis operated on in the
clinic from 2008 to 2021, 24 patients with two-level
lumbar spondylolysis and spondylolisthesis were
included in the analyzed group. Middle-aged patients
dominated, from (35-55 years -15), (55-70 years-9)
patients, which was associated with heavy physical
work, obesity, beginning of menopause in women. The
predominance of men among the patients was
insignificant - 9 (37.5%) and women - 15 (62.5%). The
Japanese Orthopedic Association (JOA) scale and
visual analogue scale (VAS) were used to assess
preoperative and postoperative neurological function
and back pain. Dual-level spondylolisthesis occurred at
the L2/L3 and L3/L4 levels in one patient, at the L3/4
and L4/L5 levels in 11 patients, and at the L4/L5 and
L5/S1 levels in 12 patients. The most frequent
localization of double lumbar spondylolisthesis was L3-
L5. Before surgery, patients underwent radiographs of
the lumbar spine in lateral, flexion, and extension
movements; sagittal computed tomography (CT); and
magnetic resonance imaging (MRI). All patients
underwent decompression, reposition, and posterior
interdiv fusion of the lumbar spine with autogenous
bone shavings from the posterior decompression or
cage. Patients were followed up for two years after
surgery; meanwhile, intervertebral disc height was
measured at follow-up, and all data were analyzed in
statistical analysis . After surgery, the main symptoms
(neurological dysfunction and low back pain) improved
significantly. Comparison of JOA and VAS scores
indicated an effective recovery of neurological
function (p < 0.05). Postoperative follow-up showed
satisfactory interdiv fusion and interarticular healing.
Two-stage
decompressive-stabilizing
surgeries
consisted in removing the posterior-upper parts of the
underlying vertebral div from the posterior access 3
to 36 months after the anterior interdiv fusion.
Posterior
decompressive-stabilizing
surgeries
consisted of one-stage decompression and interdiv
stabilization by posterior access. During anterior
stabilizing surgery, right retroperitoneal access to the
bodies of lumbar vertebrae was performed, a
discectomy was performed, and a bone autograft was
tightly placed between the vertebral bodies. In cases
of grade III-IV displacement, percutaneous Korzh
spondylodesis
was
performed.
Anterior
decompressive stabilizing surgery consisted in
removing the div of the underlying vertebra up to the
dura mater (i.e., decompression) from retroperitoneal
access followed by interdiv fusion with autograft or
some kind of implant (including porous nickel
titanium).
RESULTS AND DISCUSSION
Analysis of the results of surgical treatment was
performed in different terms of the postoperative
period: early (up to 3 months), immediate (up to 6
months) and long-term (1 year and more). In the
postoperative period, they underwent review
radiography after 1, 3 and 6 months and after 1 year to
monitor the postoperative effect and the rate of bone
graft adhesion.
14
Volume 04 Issue 02-2022
The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN
–
2689-1026)
VOLUME
04
I
SSUE
02
Pages:
12-16
SJIF
I
MPACT
FACTOR
(2020:
5.
286
)
(2021:
5.
64
)
OCLC
–
1121105510
METADATA
IF
–
7.569
Publisher:
The USA Journals
During the same periods, the dynamics of orthopedic
and neurological symptoms regression, social
rehabilitation of the patients were assessed, clinical
and radiological comparisons were made, and the
causes of errors and complications were analyzed.
Radiological signs of graft remodeling in interdiv
fusion were evident as early as 3 months, forming a
fibrous adhesion by 6 months and a bone block by 11.5
years of age. Analysis of the clinical results of surgical
treatment of spondylolisthesis showed that the
majority of patients (92%) had positive results in the
long-term period. The study of the dynamics of
recovery of neurological disorders indicates that the
best results were observed in patients who underwent
not only stabilization, but also targeted decompression
of the spinal canal nerve structures. The orthopedic
manifestations in the long-term period were
characterized by restriction of movements in the
lumbar spine associated mainly with internal
stabilization of the spine and development of bone
block.
The number of unsatisfactory results in the long-term
period was 8%. The analysis showed that all patients
had poor treatment results due to either technical or
tactical errors. It follows that the development of
correct indications for surgical interventions and their
error-free execution can minimize the number of
unsatisfactory outcomes, thereby improving the
results of surgical treatment in patients with
spondylolisthesis.
The
following
complications
occurred: delayed urination, temporary increase in
radicular symptoms, and suppuration of the surgical
wound (1 patient). In the distant postoperative period,
the main complications were associated with the
progression or development of degenerative-
dystrophic processes in the overlying segments of the
spine. The results of surgical treatment of
spondylolisthesis, despite the great successes
achieved by domestic and foreign medicine, even
according to the materials of leading clinics, are
positive only in 80-85% of patients. The nature of the
operation performed and the result of treatment
undoubtedly depend on the localization, severity and
prevalence of pathological changes in the spine, the
nature of their relationship with the neural formations
of this area. Differentiated application of various
methods of surgical treatment of double-trunk
spondylolisthesis with regard to the type and stage of
the disease makes it possible to significantly increase
the effectiveness of surgical treatment. It follows that
the development of correct indications for surgical
interventions and their error-free execution can reduce
the number of unsatisfactory outcomes to a minimum,
thus improving the results of surgical treatment of
patients with bilobar spondylolisthesis. There is
currently no doubt that decompressive-stabilizing
surgeries are the operations of choice for two-level
spondylolisthesis, aimed at eliminating the causes of
neurologic symptoms and creating a bone block
between the vertebrae at the level of displacement.
We performed clinical and radiological examination
before a) and after b) surgery. (Fig-1)
15
Volume 04 Issue 02-2022
The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN
–
2689-1026)
VOLUME
04
I
SSUE
02
Pages:
12-16
SJIF
I
MPACT
FACTOR
(2020:
5.
286
)
(2021:
5.
64
)
OCLC
–
1121105510
METADATA
IF
–
7.569
Publisher:
The USA Journals
Fig.1.We performed clinical and radiological examination before a) and after b) surgery
Fig-2. Photo of the patient 6 months after spinal function surgery.
CONCLUSIONS
Thus, we can say that the results obtained allow us to
conclude that the considered pathology of the spine
requires close attention, since the spinal cord and its
formations are involved in the pathological process.
The results of treatment of patients with two-level
lumbar spondylolisthesis allow us to consider it
clinically justified. The use of decompressive-stabilizing
surgery with TPF (transpedicular fixator) helps to
implement such tactics, which will significantly
alleviate pain and reduce disability in patients and
provide a good prognosis.
А
В
А
в
16
Volume 04 Issue 02-2022
The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN
–
2689-1026)
VOLUME
04
I
SSUE
02
Pages:
12-16
SJIF
I
MPACT
FACTOR
(2020:
5.
286
)
(2021:
5.
64
)
OCLC
–
1121105510
METADATA
IF
–
7.569
Publisher:
The USA Journals
REFERENCES
1.
Venger V.F., Kulazhenko E.V. The role of the
arcuate joints in the functioning of the vertebral
segment
system
and
the
genesis
of
spondylolisthesis:
article
of
the
scientific
conference "Vertebrology - problems, searches,
solutions". М., 2008. С. 181-183.
2.
Voronovich I.R., Dulub O.I., Nikolaev V.N.
Spondylolisthesis. Minsk, 2019.
3.
Vreden P.P. Spondylolysis and spondylolisthesis:
prakt. ruk. po ortopedy. Leningrad, 2016
4.
Dotsenko V.V., Karyakin H.H., Starikov H.A.,
Berbenev C.B. The use of ventral access in surgical
treatment
of
lumbar
osteochondrosis
//
Neurosurgery. 2000. № 1-2. С. 12-15.
5.
Zavelya M.I. Diagnostics of osteochondrosis of the
lumbar spine: Ph. Candidate of medical sciences.
Kharkov, 2012.
6.
Korzh A.A., Khwisyuk N.I., Sak H.H. Some problems
of etiology and pathogenesis of osteochondrosis
of the lumbar spine // Orthopedic, Traumatol. and
Prosthesir. 2017 №
7.
Harmon P.H.. Anterior extraperitoneal lumbar disc
excision and vertebral div fusion // Clinical
Orthopaedics: book. Philadelphia; Montreal:
Lippincott, 2020. P. 169-198. 1
8.
Posner I., White A.A., Edwards W.T., Hayes W.C. A
biomechanical analysis of the clinical stability of the
lumber and lumbosacral spine // Spine. 2021 Vol.
7(4). P. 374-389.
9.
Reddi A.H.. Cell biology and biochemistry of
endochondral bone development // Coll. Rel. Res.
2018. Vol. 1(2). P. 209-226.
