Clinical Efficacy And Imaging Manifestations Of Surgical Treatment For Severe Lumbar Isthmic Spondylolisthesis

Purpose: To evaluate the clinical efficacy and radiological manifestations of the surgeries for severe lumbar isthmic spondylolisthesis. Methods: 21 patients with severe Lumbar Isthmic Spondylolisthesis who underwent surgery treatment were enrolled in the study group. 42 matched patients with mild Lumbar Isthmic Spondylolisthesis were enrolled in the control group. The VAS score, ODI index, lumbar JOA score and the degree of spondylolisthesis, lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT) and pelvic incidence(PI) were used to evaluate the clinical efficacy pre- and postoperatively. All the complications were recorded. Results: The average follow-up time was 26.95 +/- 18.58 months in the study group, while it was 30.95 +/- 18.86 months in the control group. The VAS score and ODI index were significantly decreased (P < 0.05) but Lumbar JOA score increased significantly in both groups at the last follow-up (P < 0.05). The average degree of spondylolisthesis and LL also decreased in the last follow-up in both groups (P < 0.05). But the SS, PT, PI were not significantly improved in both group (P > 0.05). In the study group, 5 cases had transient neurological symptoms in lower extremities, one had minor pulmonary embolism, and two cases had screw breakage and reoperation. Only one case of postoperative neurological symptoms occurred in the control group. The differences between the patients who got the complete reduction and those who didn't showed no difference. But the difference between the patients with/without interbody fusion was found. Conclusions: Surgical treatments for severe Lumbar Isthmic Spondylolisthesis were satisfactory. Slippage should be reduced while complete reduction may not be necessary. The interbody fusion was suggested if possible.