Application of the isolated anterior surgery for the treatment of low-grade isthmic spondylolisthesis
Keywords:
Anterior lumbar interbody fusion, low-grade isthmic spondylolisthesisAbstract
Introduction. Anterior lumbar interbody fusion (ALIF) at the L5-S1 level is a reliable treatment option for degenerative diseases of the spine, but remains controversial for low-grade isthmic L5 spondylolisthesis. The generally accepted methods (gold standard) are PLIF or TLIF (mis vs open) supplemented with transpedicular stabilization [1,2,3,4]. In evaluating the results of surgical treatment, there is no reliable evidence that posterior fusion is superior to ALIF in outcome.
Objective. The study was aimed at evaluation of clinical and radiological outcomes and analysis of the efficacy and safety of stand-alone anterior interbody fusion (ALIF) with simultaneous bone plate fixation in the treatment of low grade isthmic L5 spondylolisthesis, as well as at identification of risk factors for implantfailure and pseudarthrosis development.
Materials and Methods. A retrospective analysis of patients operated on for low-grade isthmic L5 spondylolisthesis (n=196) in the period from 2015 to 2020 was performed. Of these, a separate group of 29 patients operated on using the stand-alone ALIF technique with bone plate fixation was evaluated..
Results. A number of parameters that influenced fusion failure and pseudarthrosis development were identified: the presence of isthmic spondylolisthesis, the preoperative L5 translation volume more than 6 mm, and pelvic incidence (PI)≥60°.
Conclusion. The use of the ALIF technique with bone plate fixation leads to good results when taking into account the parameters of the sagittal balance and the combination of predictive factors of spinal fusion failure.
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