YOSH OLIMLAR
ILMIY-AMALIY KONFERENSIYASI
in-academy.uz/index.php/yo
23
ASSESSMENT OF TRANSPEDICULAR SCREW FIXATION COMBINED WITH
POSTERIOR INTERBODY FUSION USING CAGE IN THE TREATMENT OF
LUMBAR SPONDYLOLISTHESIS
Safarov Jasur Temurovich
Neurosurgeon at the Bukhara Regional Multidisciplinary Hospital
https://doi.org/10.5281/zenodo.14011133
Introduction
Spondylolisthesis, characterized by a defect in the vertebral div at the pars
interarticularis, occurs when instability leads to the vertebral div shifting forward. This
sagittal subluxation of one vertebra over another is a common form of intervertebral
instability. The first recorded case was documented in 1772 by obstetrician Herbinaux, who
described lumbosacral spondylolisthesis causing challenges in childbirth due to the forward
displacement of L5 on the sacrum.
Spondylolisthesis can arise from various causes, including congenital, isthmic,
degenerative, traumatic, pathological, or postoperative origins. Prevalence varies, with L5-S1
commonly affected in children and about 5% of adult men and 10% of adult women showing
spondylolisthesis without pars defects.
Patients often present with lower back pain, neurological symptoms, and/or radicular
complaints, most frequently affecting the L3-S1 vertebrae. Symptoms typically worsen with
activities like repetitive extension or rotation, while resting offers relief.
Modern surgical approaches, such as bilateral posterolateral fusion (PLF), show an 81-
100% fusion success rate and a 60-98% clinical success rate. This study aims to evaluate the
effectiveness of treating lumbar and lumbosacral spondylolisthesis using transpedicular
screw fixation and posterior interdiv fusion with cage insertion.
Materials and Methods
This prospective and retrospective study included 25 cases of lumbar spondylolisthesis
treated at the Scientific and Practical Center of Neurosurgery of the Republic of Uzbekistan
Inclusion Criteria
included patients aged 20–50 with confirmed spondylolisthesis who
experienced severe low back pain, neurological deficits (motor, sensory, or sphincteric
issues), and unresponsive symptoms after conservative treatment. Patient improvement was
assessed pre- and post-operatively using the Visual Analog Scale (VAS) for pain and the
Oswestry Disability Index (ODI) for disability. VAS measurements evaluated low back pain in
moving, standing, and sitting postures.
Exclusion Criteria
involved patients under 20, those with less than three months of
back pain, asymptomatic spondylolisthesis, Grade 5 spondylolisthesis, or congenital spinal
deformities.
Data Collection
included personal demographics, the onset and progression of illness,
and other relevant medical history.
Results
This prospective and retrospective study included 25 lumbar spondylolisthesis cases
treated at the Scientific and Practical Center of Neurosurgery of the Republic of Uzbekistan.
Preoperative imaging, including static and dynamic X-rays, DEXA scans, CT, and MRI as
YOSH OLIMLAR
ILMIY-AMALIY KONFERENSIYASI
in-academy.uz/index.php/yo
24
needed, was conducted to assess spine anatomy, fracture and canal dimensions, and neural
compression. Most cases (76%) involved the L4-L5 level.
Radiographs confirmed fusion cage placement and transpedicular screw positioning,
with interdiv fusion at L4-L5 in 64% of cases, followed by L5-S1 in 12% and other levels.
Preoperative VAS pain scores averaged 7.64, reduced to 3.52 one week postoperatively and
2.32 after six months, indicating substantial improvement. Fixation levels were
predominantly L4-L5 (64%) and L3-L4-L5 (12%). Mean surgery time was 95.59 minutes, with
an average hospital stay of 2.37 days.
ODI scores improved significantly, dropping from a preoperative mean of 52.16% to
13.92% postoperatively (6 months), with an overall improvement of 38.28% (P < 0.001).
The preoperative Young Adult T-score index ranged from 0.9 to 1.2, with a median of 0.4
± 0.69. Six months postoperatively, this range remained consistent, showing no statistically
significant change compared to the preoperative score.
Most patients (92%) experienced no complications, with only one case (4%) of
cerebrospinal fluid (CSF) leak and one case (4%) of superficial wound infection. Mean blood
loss was 480.0 ± 87.8 cc, ranging from 300 to 700 cc.
Regarding radiculopathy improvement, 9 patients (36%) showed good improvement, 8
(32%) showed fair improvement, 7 (28%) experienced great improvement, and one patient
showed no improvement.
Discussion
Many cases of spondylolisthesis are asymptomatic. Despite differences in causes, age,
sex, and pathology among various types of spondylolisthesis, common symptoms include back
pain, radicular pain, neurogenic claudication, deformities such as kyphosis or scoliosis, and
gait disturbance.
This study aimed to assess the effectiveness of posterior interdiv fusion with cage and
transpedicular screw fixation for lumbar and lumbosacral spondylolisthesis treatment.
Among group A patients, the average age was 57.85 ± 5.49 years, and in group B, it was 56.55
± 6.63 years. Females comprised a majority in both groups (70% in group A and 65% in group
B), similar to findings by Ghogawala and Moussa, who also reported higher female prevalence
in spondylolisthesis studies.
Our study population, ranging from 26 to 65 years, had a median age of 43.92 ± 9.94
years, with the most common age group being 18-40 years (52%). Females were predominant
(60%), with a male-to-female ratio of 0.67:1. These results are consistent with Mowafy et al.,
who examined transpedicular fixation and interdiv fusion techniques in spondylolisthesis
cases, highlighting the female majority and similar age ranges among patients.
Conclusion
Surgical intervention is typically required for spondylolisthesis when conservative
treatments prove ineffective. Transpedicular fixation combined with interdiv fusion is an
effective approach for managing spondylolisthesis, offering stability and neural
decompression while minimizing neurological risks. Partial repositioning and decompression
of affected nerves reduce the likelihood of complications. Future studies should focus on
larger, multicenter trials with long-term follow-up to further validate these findings and
enhance treatment protocols for spondylolisthesis management.
YOSH OLIMLAR
ILMIY-AMALIY KONFERENSIYASI
in-academy.uz/index.php/yo
25
References:
1.
Fredrickson B, Baker D, McHolick WJ. The natural history of spondylolysis and
spondylolisthesis. J Bone Joint Surg Am. 1984;66:699–707.
2.
Herbinaux G. Traite sur divers. Accouchement laborieu et sur l^es polipe de la matrice.
Brussels: J.L. De Boubers; 1782.
3.
Majid K, Fischgrund JS. Degenerative lumbar spondylolisthesis: trends in management. J
Am Acad Orthop Surg. 2008;16:208–215.
4.
Mostofi K, Gharaie Moghaddam B, Karimi Khouzan R, Daryabin M. The reliability of
LERI's sign in L4 and L3 radiculalgia. J Clin Neurosci. 2018;50:102–104.
https://doi.org/10.1016/j.jocn.2018.01.025.
5.
Kalichman L, Kim DH, Li L. Spondylolysis and spondylolisthesis: prevalence and
association with low back pain in the adult community-based population. 2009:199–205.
6.
Garry J, McShane J. Lumbar spondylolysis in adolescent athletes. Spine. 1988;47:145–
149.
7.
Jacobs WC, Vreeling A, De Kleuver M. Fusion for low grade adult isthmic
spondylolisthesis: a systematic review of the literature. Eur Spine J. 2006;15:391–402.
8.
Crawford EJ, Ravinsky RA, Coyte PC, Rampersaud YR. Lifetime incremental cost-utility
ratios for minimally invasive surgery for degenerative lumbar spondylolisthesis relative to
failed medical management compared with total hip and knee arthroplasty for osteoarthritis.
Can J Surg. 2021;64
9.
https://doi.org/10.1503/cjs.015719
. PMID: 34296707; PMCID: PMC8410474.
10.
Mowafy O, Gameel I, El-Zayat T, Abo El Khir M. Comparative study between
transpedicular screws fixation with and without interdiv fusion using cages in lumbar
spondylolisthesis.
Al-Azhar
Int
Med
J.
2022;3:35–39.
https://doi.org/10.21608/aimj.2022.106779.1666.
11.
Ghogawala Z, Dziura J, Butler WE. Laminectomy plus fusion versus laminectomy alone
for lumbar spondylolisthesis. N Engl Med. 2016;374:1424–1434.
12.
Moussa AA, Ali MS, Galal M. Outcome of transpedicular screw fixation with posterior
interdiv fusion in management of spondylolisthesis. Int J Med Arts. 2020;2:358–364.
13.
Benguluri R, Kumar CS. Surgical management of spondylolisthesis by pedicular screw
rod system and posterolateral fusion. IOSR J Dent Med Sci. 2018;17:61–70.
https://doi.org/10.9790/0853-1704056170.
