성인의 척추분리형 척추전방전위증에서 후방 추체간 유합술과 척추경 나사못을 이용한 후외방 유합술의 결과 비교

Abstract

Study design: This was a retrospective study that analyzed and compared the results between a posterior lumbar interbody fusion, and a posterolateral fusion (PLIF+PLF), and PLF alone, in the treatment of spondyolytic spondylolisthesis in adults. Objectives: To evaluate the outcomes of two surgical treatment methods for spondylolytic spondylolisthesis-posterolateral fusion alone, and circurnferential fusion, using posterior lumbar interbody fusion and posterolateral fusion. Summary of Literature Review: There have been many reports regarding the surgical treatment of spondytolisthesis. Posterior lumbar interbody fusions have certain distinct mechanical advantages over posterolateral ones. However, the clinical and radiological results do not usually correlate. Materials and Methods: Between January 1998 and December 2001.38 patients, with spondylolytic spondylolisthesis, were operated on by a single surgeon. Nineteen patients underwent a posterolateral fusion alone (group I), with the same number undergoing an additional posterior lumbar interbody fusion (groupⅡ). These two groups were evaluated for their clinical outcomes, radiological measurements and fusion rates. Results: The losses in the slip reduction were 7.1 and 1.3% in the PLF and PLF+PLIF groups, respectively (P<0.05). The losses in the Meschan angle were 3.3 and 0.2 in the PLF and PLF+PLIF groups, respectively (P<0.05). The losses in the disc height restoration were 10.4 and 3.8% in the PLF and PLF+PLIF groups, respectively (P<0.05). A nonunion was observed in 3 of the PLF cases (15.8%) and 1 of the PLF+PLIF (5.3%). However, the satisfactory clinical results were 84.2 and 73.7% in the PLF and PLF+PLIF groups, respectively (P>0.05). Conclusions: Although the addition of a posterior lumbar interbody fusion, to an instrumented posterolateral fusion, following decompression, is more predictable in maintaining a correction and achieving union, a posterolateral fusion may have a better clinical outcome in patients with low grade spondylolytic spondylolisthesis. Therefore, careful patient selection is necessary for each operation.