• Journal of Korean Neurosurgical Society
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• v.40 no.5
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• pp.346-350
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• 2006

Objective : The ability to induce segmental lordosis has been reported to be marginal with transforaminal lumbar interbody fusion[TLIF]. Therefore, we analyzed the short-term radiological outcomes of TLIF using $8^{\circ}$ wedged cages for isthmic spondylolisthesis. Methods : Twenty-seven patients with isthmic spondylolisthesis who underwent single level TLIF with pedicle screw fixation[PSF] using $8^{\circ}$ wedged cages were retrospectively evaluated. Changes in disc height, degree of anterolisthesis, segmental lumbar lordosis, whole lumbar lordosis and L1 axis S1 distance were evaluated using standing lateral radiographs before surgery, at 6 weeks follow-up and at the final follow-up. Results : The mean age of the patients was 49.9 years [range, 38 to 64 years]. The affected levels were L4-5 in 17 cases and L5-S1 in 10. There were 18 cases of Grade I isthmic spondylolisthesis and 9 cases of Grade II. At a mean follow-up duration of 9.9 months [range, 6 to 18 months], the disc height [p< 0.001] was significantly increased, and the degree of anterolisthesis was significantly reduced [p< 0.001]. Regarding the sagittal balance, the segmental lumbar lordosis was significantly increased [p=0.01], but other parameters were not significantly changed after surgery. Conclusion : TLIF with PSF using $8^{\circ}$ wedged cages significantly increased the segmental lumbar lordosis.

• Journal of Korean Neurosurgical Society
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• v.38 no.4
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• pp.320-322
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• 2005

A 45-year-old man presented with lower back pain and pain in the right leg of 3years duration. A plain radiographic examination revealed grade I isthmic spondylolisthesis, with instability at L4-5. Computed tomography and magnetic resonance imaging demonstrated bilateral foraminal stenosis, with soft foraminal disc herniation on the right side at the L4-5 level. He underwent anterior lumbar interbody fusion[ALIF] with percutaneous posterior fixation[PF] at the L4-5 level. Without removing the posterior bony structures, removal of foraminal disc herniation and reduction of spondylolisthesis were successfully performed using ALIF with percutaneous PF. When there is no hard disc herniation or lateral recess stenosis, ALIF with percutaneous PF can be one of the treatment options for isthmic spondylolisthesis, even in the presence of foraminal disc herniation, as in our case.

• Journal of Korean Neurosurgical Society
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• v.40 no.3
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• pp.175-179
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• 2006

Objective : The surgical outcome of anterior lumbar interbody fusion[ALlF] with pedicle screw fixation for elderly isthmic spondylolisthesis was analyzed. Methods : Consecutive nineteen elderly patients [aged 65 years or more] with isthmic spondylolisthesis [Grade I or II] who underwent single level ALIF with pedicle screw fixation in 2002 were analyzed. Using clinical chart and mailed questionnaires, preoperative and postoperative Visual Analogue Scale[VAS] of back and leg pain and postopertive Macnab criteria were evaluated. Results : The mean age at the time of operation was 68.4 years [range 65 to 78 years]. Twelve patients underwent ALIF with percutaneous pedicle screw fixation. Seven patients underwent ALIF followed by posterior decompression and pedicle screw fixation. The postoperative complication rate was 10.5% [wound dehiscence in 1 patient and incisional hernia in 1 patient]. There was no postoperative major morbidity or mortality. At a mean follow-up duration of 30.7 months [range 25 to 35 months], 93.3% [14/15] of the patients showed excellent or good outcomes in terms of Macnab criteria. The mean VAS scores of back pain and leg pain significantly decreased after surgery. Conclusion : ALIF with pedicle screw fixation yielded favorable results for elderly isthmic spondylolisthesis in selected cases.

• Journal of Korean Neurosurgical Society
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• v.41 no.6
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• pp.377-381
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• 2007

Objective : The aim of this study was to evaluate the morphometric changes in neuroforamen in grade I isthmic spondylolisthesis by anterior lumbar interbody fusion [ALIF]. Methods : Fourteen patients with grade I isthmic spondylolisthesis who underwent single level ALIF with percutaneous pedicle screw fixation were enrolled. All patients underwent standing lateral radiography and magnetic resonance imaging [MRI] before surgery and at 1 week after surgery. For quantitative analysis, the foraminal height, width, epidural foraminal height, epidural foraminal width, and epidural foraminal area were evaluated at the mid-portion of 28 foramens using T2-weighted sagittal MRI. For qualitative analysis, degree of neural compression in mid-portion of 28 foramens was classified into 4 grades using T2-weighted sagittal MRI. Clinical outcomes were assessed using Visual Analogue Sale [VAS] scores for leg pain and Oswestry disability index before surgery and at 1 year after surgery. Results : The affected levels were L4-5 in 10 cases and L5-S1 in 4. The mean foraminal height was increased [p<0.001], and the mean foraminal width was decreased [p=0.014] significantly after surgery. The mean epidural foraminal height [p<0.001], epidural foraminal width [p<0.001], and epidural foraminal area [p<0.001] showed a significant increase after surgery. The mean grade for neural compression was decreased significantly after surgery [p<0.001]. VAS scores for leg pain [p=0.001] and Oswestry disability index [p=0.001] was decreased significantly at one year after surgery. Conclusion : Foraminal stenosis in grade I isthmic spondylolisthesis may effectively decompressed by ALIF with percutaneous pedicle screw fixation.

• Journal of Korean Neurosurgical Society
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• v.59 no.3
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• pp.292-295
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• 2016

Objective : To investigate the variation of pelvic radius and related parameters in low-grade isthmic lumbar spondylolisthesis. Methods : Seventy-four patients with isthmic lumbar spondylolisthesis and 47 controls were included in this study. There were 17 males and 57 females between 30 and 66 years of age, including 30 with grade I slippages and 44 grade II slippages; diseased levels included 34 cases on L4 and 40 cases on L5. Thoracic kyphosis (TK), the pelvic radius (PR), the pelvic angle (PA), pelvic morphology (PR-S1), and total lumbopelvic lordosis (PR-T12) were assessed from radiographs. Results : Statistically significant differences were found for the PA, PR-T12, and PR-S1 ($24.5{\pm}6.6^{\circ}$, $83.7{\pm}9.8^{\circ}$, and $25.4{\pm}11.2^{\circ}$, respectively) of the patients with spondylolisthesis and the healthy volunteers ($13.7{\pm}7.8^{\circ}$, $92.9{\pm}9.2^{\circ}$, and $40.7{\pm}8.9^{\circ}$, respectively). The TK/PR-T12 ratios were between 0.15 and 0.75. However, there were no differences in all the parameters between the L4 and L5 spondylolysis subgroups (p>0.05). The TK and PR-S1 of grade II were less than grade I, but the PA was greater. The PR-T12 of female patients were less than male patients, but the PA was greater (p<0.05). Conclusion : Pelvic morphology differed in patients with low-grade isthmic lumbar spondylolisthesis compared to controls. Gender and the grade of slippage impacted the sagittal configuration of the pelvis, but the segment of the vertebral slip did not. Overall, the spine of those with spondylolisthesis remains able to maintain sagittal balance despite abnormal pelvic morphology.

• Journal of Korean Neurosurgical Society
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• v.30 no.sup1
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• pp.108-114
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• 2001

Objective : Posterior lumbar interbody fusion(PLIF) provides the favorable outcome to degenerative lumbar disease, especially isthmic spondylolisthesis. To determine the long-term effect of PLIF using psterior movable segment, we analysed the results of follow-up radiologic changes and surgical outcome retrospectively Patients and Method : During the past 11 years(1989. 1.-1999. 9.), 148 patients with symptomatic lumbar spondylolisthesis were managed at our department and the clinical wants were throughly recieved and final outcome is determined at last follow up. PLIF using antogenous bone(posterior movable segment, iliac bone and rib) were performed in 106 case. Results : After an average follow-up period of 33 months(range ; 15-58 months), the results were excellent in 66 cases, good in 37 cases, fair in 2 cases and poor in 1 cases. And the satisfactory results were 103 cases(98.2%) in PLIF,. Conclusion : In conclusion, patients who underwent PLIF with autologous bone graft had good clinical and radiological outcomes without significant neurological complications.

• Journal of Korean Neurosurgical Society
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• v.53 no.2
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• pp.96-101
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• 2013

Objective : The purpose of this study was to analyze the differences of spinopelvic parameters between degenerative spondylolisthesis (DSPL) and isthmic spondylolisthesis (ISPL) patients. Methods : Thirty-four patients with DSPL and 19 patients with ISPL were included in this study. Spinopelvic parameters were evaluated on whole spine X-rays in a standing position. The following spinopelvic parameters were measured : pelvic incidence (PI), sacral slope, pelvic tilt (PT), lumbar lordosis (LL), and sagittal vertical axis from C7 plumb line (SVA). The population of patients was compared with a control population of 30 normal and asymptomatic adults. Results : There were statistically significant differences in LL (p=0.004) and SVA (p=0.005) between the DSPL and ISPL group. The LL of DSPL ($42{\pm}13^{\circ}$) was significantly lower than that of the control group ($48{\pm}11^{\circ}$; p=0.029), but that of ISPL ($55{\pm}6^{\circ}$) was significantly greater than a control group (p=0.004). The SVA of DSPL ($55{\pm}49$ mm) was greater than that of a control group (<40 mm), but that of ISPL ($21{\pm}22$ mm) was within 40 mm as that of a control group. The PT of DSPL ($24{\pm}7^{\circ}$) and ISPL ($21{\pm}7^{\circ}$) was significantly greater than that of a control group ($11{\pm}6^{\circ}$; p=0.000). Conclusion : Both symptomatic DSPL and ISPL patients had a greater PI than that of the asymptomatic control group. In conclusion, DSPL populations are likely to have global sagittal imbalance (high SVA) compared with ISPL populations because of the difference of lumbar lordosis between two groups.

• The Journal of Korean Physical Therapy
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• v.15 no.4
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• pp.24-33
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• 2003

Spondylolysis and spondylolisthesis are two conditions that directly involve changes in the vertebra. Spondylolysis is defined as a defect in the pars interarticularis, the region of the lamina between the superior and inferior articular facets. Progression of the defect can result in spondylolisthesis, which is defined as a subluxation or 'slippage' of two adjacent vertebrae. In the low back it occurs most commonly at the lumbosacral level; next in frequency is spondylolisthesis of the fourth lumbar vertebra on the fifth. To provide the reader with information about the aetiology and anatomical consideration of spondylolysis and spondylolisthesis type. Spondylolisthesis has recently been classified by Wiltse and others into five types based on the suspected aetiology; dysplastic, isthmic, degenerative, posttraumatic, pathologic and postsurgical. Of these five types, isthmic spondylolisthesi and degenerative spondylolisthesis, both of which are frequently associated with low back and lower limb pain.

• Journal of Korean Neurosurgical Society
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• v.54 no.2
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• pp.128-131
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• 2013

Transforaminal lumbar interbody fusion (TLIF) is commonly used procedure for spinal fusion. However, there are no reports describing anterior cage dislodgement after surgery. This report is a rare case of anterior dislodgement of fusion cage after TLIF for the treatment of isthmic spondylolisthesis with lumbosacral transitional vertebra (LSTV). A 51-year-old man underwent TLIF at L4-5 with posterior instrumentation for the treatment of grade 1 isthmic spondylolisthesis with LSTV. At 7 weeks postoperatively, imaging studies demonstrated that banana-shaped cage migrated anteriorly and anterolisthesis recurred at the index level with pseudoarthrosis. The cage was removed and exchanged by new cage through anterior approach, and screws were replaced with larger size ones and cement augmentation was added. At postoperative 2 days of revision surgery, computed tomography (CT) showed fracture on lateral pedicle and body wall of L5 vertebra. He underwent surgery again for paraspinal decompression at L4-5 and extension of instrumentation to S1 vertebra. His back and leg pains improved significantly after final revision surgery and symptom relief was maintained during follow-up period. At 6 months follow-up, CT images showed solid fusion at L4-5 level. Careful cage selection for TLIF must be done for treatment of spondylolisthesis accompanied with deformed LSTV, especially when reduction will be attempted. Banana-shaped cage should be positioned anteriorly, but anterior dislodgement of cage and reduction failure may occur in case of a highly unstable spine. Revision surgery for the treatment of an anteriorly dislodged cage may be effectively performed using an anterior approach.

• Journal of Korean Neurosurgical Society
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• v.45 no.2
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• pp.74-80
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• 2009

Objective : To evaluate clinical and radiological results of two different fusion techniques in adult low-grade isthmic spondylolisthesis. Methods : Between November 2003 and December 2004, 46 consecutive patients underwent instrumented mini-transforaminal lumbar interbody fusion (mini-TLIF) (group I) at Wooridul Spine Hospital, Seoul, Korea. Between February 2003 and October 2006, 32 consecutive patients underwent instrumented circumferential fusion (group II) at Leon Wiltse Memorial Hospital, Suwon, Korea. The mean follow-up periods were 29.7 and 26.1 months, respectively. Results : Mean visual analog scale (VAS) scores for back and leg pain decreased, respectively, from 6.98 and 6.33 to 2.3 and 2.2 in group I and from 7.38 and 6.00 to 1.7 and 1.0 in group II. Mean Oswestry disability index (ODI) improved from 51.85% to 14.4% in group I and from 60% to 9.1% in group II. In both groups, VAS and ODI scores significantly changed from pre- to postoperatively (p<0.001), but postoperative outcome between groups was statistically not significant. Radiologic evidence of fusion was noted in 95.7% and 100% of the patients in group I and II, respectively. In both groups, changes in disc height, segmental lordosis, degree of listhesis, and whole lumbar lordosis between the pre- and postoperative periods were significant except whole lumbar lordosis in both groups. Conclusion : Clinical and functional outcomes demonstrate no significant differences between groups in treating back and leg pain of adult patients with low-grade isthmic spondylolisthesis. However, in terms of operative data (i.e. operation time and hospital stay), instrumented mini-TLIF demonstrated better results.