Detaillierte Beitrags-Information
| Beitragstitel | Stand-alone Anterior Lumbar Interbody Fusion (ALIF) for grade I isthmic spondylolisthesis |
|---|---|
| Beitragscode | P031 |
| Autoren | |
| Präsentationsform | Poster |
| Themengebiete |
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| Abstract |
Introduction.The surgical treatment of isthmic spondylolisthesis (ISP) remains controversial. For low grade ISP the majority of the literature suggests a posterior approach, decompression and pedicle screw instrumentation, with or without interbody fusion (TLIF,PLIF). Usually anterior interbody fusion (ALIF), is always combined with posterior instrumentation for the treatment of ISP. There is only limited literature about standalone ALIF for ISP. The aim of this study is to retrospectively analyze the clinical and radiological outcome of a large cases series treated with ALIF stand alone in our institution. Methods. All cases with grade I ISP treated with ALIF between 10/2012 and 12/2016 were analyzed regarding demographic data, affected level,bone graft used and postoperative pain (VAS). The latest available follow up imaging was used to detect bony fusion. Any revision and complications were recorded. Results. 125 Grade 1 ISP cases (71 f, 54 m) were treated with ALIF stand alone (115 in L5/S1;10 in L4/5). In 92 patients (103 levels) the cage was filled with matrix graft product (rhBMP-2), 32 patients (32 levels) received iliac crest autograft and one case DBM. Follow up was 10.3 months. The overall fusion rate was 92.7%. There was no association between the graft used and the fusion rate (p=0.287). Despite the high fusion rate, during the follow up period, 39 of the patients (31%) complained for persistent back pain. The use of BMP graft was associated with an increased rate of postoperative pain (30/85=35.3%) compared with autologous graft (6/31=19.4%), but the difference did not reach a statistical significance (p=0.117).In total 12 patients a revision surgery with additional posterior stabilisation was performed (reoperation rate of 10.3%). All 12 Patients were suffering from mechanical backpain, 2 of them with confirmed non union in the 6 month postop CT Scan. In 4 Cases the posterior stabilisation was performed due to fracture of the inferior endplate. There was no case of retrograde ejaculation in our series. Conclusion. A stand-alone ALIF is an effective treatment for a Grade I ISP. In the vast majority fusion is achieved without additional posterior stabilisation. Our study confirms that the postoperative pain is not statistically correlated with bony fusion. The additional risks, complications and costs, associated with additional posterior instrumentation the treatment of Grad I ISP is an our opinion an unnessesary surgial procedure. |