• Journal of Korean Medicine Rehabilitation
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• v.32 no.1
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• pp.51-62
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• 2022

Objectives Objective of this study is to investigate the role of paraspinal muscles by examining the correlation between slip percentage (SP) of spondylolisthesis and fatty infiltration of lumbar paraspinal muscle. Methods Retrospective analysis was performed on 45 patients diagnosed with spondylolisthesis based on medical records. Using T2-weighted axial magnetic resonance imaging, cross-sectional areas (CSAs) of psoas major (PM), multifidus (MU) and erector spinae (ES) were calculated and divided by CSA of lower level vertebral body (VB). SP was measured using sagittal T2-weighted images. Correlation of SP with muscle relative cross-sectional area (RCSA) and muscle fatty infiltration by Goutallier classification was respectively analyzed using Spearman correlation. Statistic assessment conducted by Wilcoxon signed rank test and paired t-test using program GraphPad prism 5 (GraphPad Software, Inc., San Diego, CA, USA). Results Spondylolisthesis forward slip percentage by Taillard's method was negatively associated with both side MU RCSAs. No significant correlation was found between PM RCSA, ES RCSA and SP. Forward slippage was significantly correlated with fatty infiltration of lumbar paraspinal muscle measured by Goutallier classification. Conclusions This study is to understand the role of paraspinal muscle affecting spinal instability by investigating correlation between statistical deviation of lumbar muscle characters (RCSA, fatty infiltration of lumbar muscle) and SP. We found that spondylolisthesis SP is positively related to fatty infiltration of lumbar paraspinal muscle. and is negatively associated with both side MU RCSAs.

• Journal of Korean Neurosurgical Society
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• v.55 no.6
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• pp.331-336
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• 2014

Objective : The purpose of this study was to evaluate the differences in sagittal spinopelvic alignment between lumbar degenerative spondylolisthesis (DSPL) and degenerative spinal stenosis (DSS). Methods : Seventy patients with DSPL and 72 patients with DSS who were treated with lumbar interbody fusion surgery were included in this study. The following spinopelvic parameters were measured on whole spine lateral radiographs in a standing position : pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis angle (LL), L4-S1 segmental lumbar angle (SLL), thoracic kyphosis (TK), and sagittal vertical axis from the C7 plumb line (SVA). Two groups were subdivided by SVA value, respectively. Normal SVA subgroup and positive SVA subgroup were divided as SVA value (<50 mm and ${\geq}50mm$). Spinopelvic parameters/PI ratios were assessed and compared between the groups. Results : The PI of DSPL was significantly greater than that of DSS (p=0.000). The SVA of DSPL was significantly greater than that of DSS (p=0.001). In sub-group analysis between the positive (34.3%) and normal SVA (65.7%), there were significant differences in LL/PI and SLL/PI (p<0.05) in the DSPL group. In sub-group analysis between the positive (12.5%) and normal SVA (87.5%), there were significant differences in PT/PI, SS/PI, LL/PI and SLL/PI ratios (p<0.05) in the DSS group. Conclusion : Patients with lumbar degenerative spondylolisthesis have the propensity for sagittal imbalance and higher pelvic incidence compared with those with degenerative spinal stenosis. Sagittal imbalance in patients with DSPL is significantly correlated with the loss of lumbar lordosis, especially loss of segmental lumbar lordosis.

• Journal of Korean Neurosurgical Society
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• v.42 no.1
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• pp.6-10
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• 2007

Objective : The purpose of this study was to determine the effect of bone cement augmentation of pedicular screwing in severe osteoporotic spondylolisthetic patients. Methods : Twenty patients with spondylolisthesis (8 : spondylolytic spondylolisthesis 12 : degenerative spondylolisthesis) who had undergone pedicular screwing and interbody fusion for osteoporotic lumbar spine (T-score on bone mineral density<-3.0) from 2002 to 2005 were reviewed. Mean age was 62.3 years with 3 male and 17 female patients. Average follow-up period was 14 months. Average T-score on bone mineral density (BMD) was -3.62. After decompression of neural elements, about 6cc of polymethylmethacrylate (PMMA) was injected into the each vertebral body through transpedicular route. All patients underwent one level interbody fusion and pedicular screw fixation. Clinical outcome was assessed using Oswestry Disability Index (ODI) on the last clinical follow-up. In addition, a modified MacNab's grading criteria was used to objectively assess patient's outcome postoperatively. Radiographic analysis of sagittal contour was assessed preoperatively, immediately postoperatively, and at final follow-up including fusion rate. Results : Eighteen of 20 patients were graded as excellent or good according to the modified MacNab's criteria. An significant improvement of ODI was achieved in both groups. Mean sagittal angle at the preoperative state, postoperative state and at the last follow-up state was $11.0^{\circ},\;20.1^{\circ}$ and $18.3^{\circ}$, respectively, with mean sagittal angle correction gain $7.3^{\circ}$. Firm fusion was achieved in all patients. There were one compression fracture above the fused segment after 6 months follow-up and one case of seroma. But there were no postoperative complications related to bone cement leakage and pedicular screwings such as screw pullout or screw cut-up. Conclusion : Bone cement augmentation of pedicular screwing can be an effective procedure for osteoporotic lumbar spine in spondylolisthetic patients.

• 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.

• Journal of Korean Neurosurgical Society
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• v.56 no.4
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• pp.315-322
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• 2014

Objective : Posterior accessed lumbar interbody fusion (PALIF) has a clear objective to restore disc height and spinal alignment but surgeons may occasionally face the converse situation and lose lumbar lordosis. We analyzed retrospective data for factors contributing to a postoperative flat back. Methods : A total of 105 patients who underwent PALIF for spondylolisthesis and stenosis were enrolled. The patients were divided according to surgical type [posterior lumbar inter body fusion (PLIF) vs. unilateral transforaminal lumbar interbody fusion (TLIF)], number of levels (single vs. multiple), and diagnosis (spondylolisthesis vs. stenosis). We measured perioperative index level lordosis, lumbar lordosis, pelvic tilt, sacral slope, pelvic incidence, and disc height in standing lateral radiographs. The change and variance in each parameter and comparative group were analyzed with the paired and Student t-test (p<0.05), correlation coefficient, and regression analysis. Results : A significant perioperative reduction was observed in index-level lordosis following TLIF at the single level and in patients with spondylolisthesis (p=0.002, p=0.005). Pelvic tilt and sacral slope were significantly restored following PLIF multilevel surgery (p=0.009, p=0.003). Sacral slope variance was highly sensitive to perioperative variance of index level lordosis in high sacral sloped pelvis. Perioperative variance of index level lordosis was positively correlated with disc height variance ($R^2=0.286$, p=0.0005). Conclusion : Unilateral TLIF has the potential to cause postoperative flat back. PLIF is more reliable than unilateral TLIF to restore spinopelvic parameters following multilevel surgery and spondylolisthesis. A high sacral sloped pelvis is more vulnerable to PALIF in terms of a postoperative flat back.

• The Journal of Churna Manual Medicine for Spine and Nerves
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• v.7 no.1
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• pp.113-120
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• 2012

Objectives : This study was performed to report the effect of oriental medical treatment including chuna manual therapy for the spondylolisthesis patient. Methods : We treated him by oriental medical treatment including acupuncture, herb therapy and chuna manual therapy. And the result was assessed by numerical rating scale(NRS), walking distance at once and radiological examination. Results : After treatment, NRS changed from 8 to 4, walking distance at once changed from 175m to 500m, percent of slip changed from 28.62% to 19.80% and slip angle changed from $20.0^{\circ}$ to $22.8^{\circ}$. Conclusions : In this study, oriental medical treatment including chuna therapy was effective in spondylolisthesis patient. But additional studies will be needed.

• Journal of Korean Medicine Rehabilitation
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• v.31 no.1
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• pp.165-173
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• 2021

Objectives The objective of this study is to propose postoperative rehabilitation for spondylolisthesis after posterior lumbar interbody fusion (PLIF) in Korean medicine and to report its effectiveness. Methods There were two patients who were received Korean medicine with acupuncture, herbal medicine, cupping and exercise treatment after PLIF. Patients were evaluated numeric rating scale (NRS), Oswestry disability index (ODI), pain free walking distance (PFWD), Korean modified index (K-MBI), EuroQol-5 dimension (EQ-5D) index. Results Case 1 was improved NRS from 7 to 3, Case 2 was improved NRS from 7 to 2. Also, ODI, PFWD, K-MBI, EQ-5D score were improved in both cases. Conclusions This study suggests that Korean medicine rehabilitation could be effective for spondylolisthesis after PLIF.

• Journal of International Academy of Physical Therapy Research
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• v.11 no.4
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• pp.2229-2236
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• 2020

Background: Few comparative studies have been conducted on strengthening the anterior and posterior muscles of the trunk via lumbar stabilization exercises. Objectives: To compare the effects of forward leaning exercise and supine bridging exercise in stability exercise. Design: Randomized controlled clinical trial (single blind). Methods: Thirty subjects with spondylolisthesis were participated in this study. Fifteen subjects performed the bridging exercises and fifteen subjects performed the forward leaning exercises. Each exercise was held for ten seconds per repetition, and four repetitions were considered one sub-session. A total of four sub-sessions were performed in one full exercise session. The full exercise session required thirty minutes, including rest time. Trunk strength and range of motion and Oswestry disability index were measured. Results: Two weeks later, trunk flexion strength and trunk extension range of motion were significantly increased in the forward leaning exercise group than in the supine bridging group, trunk extension strength were significantly increased in the supine bridging exercise group than in the forward leaning group. After two weeks, the pain score was significantly lower in the forward leaning exercise group than in the supine bridging group. Conclusion: This study has shown that stabilization exercises are effective in increasing range of motion and strength in spondylolisthesis subjects. It was especially confirmed that the method of strengthening the anterior muscles of the trunk is more effective than the standard stabilization exercise method.

• The Journal of Churna Manual Medicine for Spine and Nerves
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• v.7 no.2
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• pp.53-61
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• 2012

Objectives : The Purpose of this study is to compare the effect of ShinBaro Pharmacopuncture Treatment and Bee Venom Pharmacopuncture Treatment of low back pain and radicular pain caused by spondylolisthesis. Methods : From January 1st,2012 to September 30th, 2012, 30 Low back pain and radicular pain patients with spondylolisthesis who were admitted to Bu-Cheon Jaseng Hospital of Oriental Medicine were divided into two groups. ShinBaro group was treated by ShinBaro Pharmacopuncture Treatment and Bee Venom group was treated by Bee Venom Pharmacopuncture Treatment. We evaluated the treatment effect of each group with numerical rating scale(NRS) and Oswestry disability index(ODI). The evaluations performed at admission day and 14th day after admission. Results : In both ShinBaro group and Bee Venom group, NRS and ODI decreased significantly in ststistics as treatment was perfomed. Though ShinBaro group showed a decreasing ODI score compared to BV group and BV group showed a decreasing NRS score compared to Shinbaro group, There is no statistical significance on NRS and ODI score after the treatment in both groups. Conclusions : The result sugguest that both ShinBaro pharmacopuncture treatment and Bee Venom pharmacopuncture treatment is considered to be effective and useful on low back pain and radicular pain caused by spondylolisthesis, although further study is needed.

• Journal of Korean Neurosurgical Society
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• v.49 no.3
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• pp.163-166
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• 2011

Objective : Both the paraspinal muscle sparing approach and percutaneous screw fixation are less traumatic procedures in comparison with the conventional midline approach. These techniques have been used with the goal of reducing muscle injury. The purpose of this study was to evaluate and to compare the safety and efficacy of the paraspinal muscle sparing technique and percutaneous screw fixation for the treatment of L5-S1 spondylolisthesis. Methods : Twenty patients who had undergone posterior lumbar interbody fusion (PLIF) at the L5-S1 segment for spondylolisthesis were prospectively studied. They were divided into two groups by screw fixation technique (Group I : paraspinal muscle sparing approach and Group II: percutaneous screw fixation). Clinical outcomes were assessed by Low Back Outcome Score (LBOS) and Visual Analogue Scale (VAS) for back and leg pain at different times after surgery. In addition, modified MacNab's grading criteria were used to assess subjective patients' outcomes 6 months after surgery. Postoperative midline surgical scarring, intraoperative blood loss, mean operation time, and procedure-related complications were analyzed. Results : Excellent or good results were observed in all patients in both groups 6 months after surgery. Patients in both groups showed marked improvement in terms of LBOSs all over time intervals. Postoperative midline surgical scarring and intraoperative blood loss were lower in Group II compared to Group I although these differences were not statistically significant. Low back pain (LBP) and leg pain in both groups also showed significant improvement when compared to preoperative scores. However, at 7 days and 1 month after surgery, patients in Group II had significantly better LBP scores compared to Group I. Conclusion : In terms of LBP during the early postoperative period, patients who underwent percutaneous screw fixation showed better results compared to ones who underwent screw fixation via the paraspinal muscle sparing approach. Our results indicate that the percutaneous screw fixation procedure is the preferable minimally invasive technique for reducing LBP associated with L5-S1 spondylolisthesis.